Thrombotic microangiopathy (TMA) remains a serious and worrying event after transplantation. We report a case of occurrence of TMA in the immediate postoperative period after a living related renal transplantation. A distinguished feature of the case was a major and early involvement of the retina with marked decreased visual acuity a long with thrombocytopenia and renal function impairment. The syndrome was completely reversible with plasma exchanges and conversion from tacrolimus to sirolimus. The patient's renal functions are excellent 11 months after transplantation. Decreased visual acuity and cotton wool exudates can be the first manifestation of post-transplantation TMA. Literature will be reviewed.