Female patient, 37 years old, black, with a history of sickle cell anaemia and end-stage chronic renal failure, on haemodialysis for 6 years. She had previously presented several episodes of sickle cell crises with the need for multiple transfusions. In November 2010 she underwent renal transplantation from a deceased donor, sharing a RD and an A, with a cold ischaemia time of 15 hours. Induction with alemtuzumab and methylprednisolone boluses was performed. During the transoperative period, the patient was hypotensive, requiring dopamine. Perfusion of the renal graft was slow, with recovery during surgery. Postoperatively, the patient became anuric, with elevated azooses and metabolic acidosis; the peripheral blood smear reported hypochromia, anisocytosis, microcytosis and dianocytosis, high density lipoproteins 677, leukocytes 17,800, neutrophils 90 %, lymphocytes 8 %, haemoglobin 7.1, haematocrit 21 %, platelets 179,000, corrected reticulocytes 5.2 %. Graft Doppler reported good vascular perfusion, but high resistance indices. A vaso-occlusive graft crisis was suspected and management with transfusions, hydroxyurea and haemodialysis was initiated. On the fifth day, a biopsy of the renal graft was performed; the most important findings were areas of infarction in peritubular capillaries with the presence of neutrophils and erythrocyte trapping, some of which were sickle-shaped, and positive C4d in 100% of the peritubular capillaries. With these findings, a diagnosis of acute humoral rejection and sickle cell crisis of the graft was made; treatment was carried out with methylprednisolone pulses, plasmapheresis, tacrolimus, mycophenolate and exchange transfusion, the latter as management of the sickle cell crisis. Ten days after transplantation, renal function improved and renal replacement therapy was discontinued. The last control creatinine, four months later, was 1.3 mg/dl.