A 17 yrs old male patient with ESRD due to SLE received his transplanted kidney from his mother. After surgery there was a very good urine output with satisfactory renal perfusion. But; soon after, the kidney was cyanosed which was disappeared by Lidocaine injection at the pedicle site. The patient was re-opened 6 hours later with removal of a thrombus and urine output was about 1000 ml/12 hours. Doppler USS showed good flow in the main vessels; however different velocities within the graft. The course was complicated by showers of pulmonary embolism later on. During this hectic course two renal tissue samples were submitted for pathological examination and plasma-pheresis was done. The case will be presented in a step-wise decision making simulating the real life scenario with feed-back response from the audience.