We present a case of a patient in stage 5 of chronic kidney disease post cadaveric renal transplantation, with dramatic postoperative course. Kidney graft function was delayed as a result of ATN, with recurrent Pseudomonas aeruginosa infections. This pathogen was found in blood and urine culture, with urinary tract as the most probable point of origin. During extensive therapy with antibiotics according to antibiogram, rapid improvement was achieved each time with return of fairly good function of the renal graft. Taking into account direct danger to patient's life due to sepsis, we considered explantation of the kidney graft. Nonetheless, patient refused to give consent for such a procedure, because he experienced each time the return of diuresis, resolution of fever, and improvement of biochemical parameters. Last onset of infection occurred in December 2008. Currently patient is in good condition, with stable kidney function, creatinine level at 2.7 mg%, GFR of 36.65 ml/min/1.73 m2, and diuresis at ca. 3000 ml/day. Control urine and blood cultures are negative. This case is presented as an example of transplantologist's dilemmas, with we can face every day in any transplant centre. Authors believe that management of such patients should be individualized and considered with adequate pragmatism.

Keywords: Kidney Transplantation