Background: Successful salvage of a failing renal allograft secondary to compromised venous outflow from acute deep venous thrombus (DVT) has not been reported in the post-operative setting.
Case Report: We present a case of acute DVT extending from the popliteal vein to the bifurcation of the inferior vena cava leading to renal allograft dysfunction in the post-operative period. The allograft was successfully salvaged with catheter directed thrombolysis of the DVT with tPA through the ipsilateral popliteal vein over a 48 hr period.
Conclusions: Post-operative renal transplant dysfunction secondary to iliac vein thrombosis can be successfully treated with catheter-directed thrombolysis using tPA.

Keywords: Venous thrombosis, renal transplantation, thrombolysis