Abstract: Acute rejection is the main complication after renal transplantation, and a major cause of chronic rejection and graft failure. The incidence of atypical acute rejection in clinical practice may affect the judgment of clinicians, thereby leading to treatment delay and severe damage to renal graft. In this study, the patient experienced an increase in the creatinine level in the early stage after renal transplantation, whereas all clinical parameters （urine volume, tacrolimus concentration, and renal graft examination） were all within the normal range. The patient was given with anti-rejection drugs and treated with human immunoglobulin. The serum creatinine level remained progressively elevated. Re-examination results of donor-specific antibody （DSA） and panel reactive antibody （PRA） were normal. Finally, the diagnosis of acute rejection mediated by cell was confirmed by renal graft biopsy. High-dose corticosteroids shock therapy was delivered. Clinical serum creatinine levels were declined. Normal results were obtained during the follow-up every week. The diagnosis and treatment of this case prompted that pathological observation during renal graft biopsy can timely and accurately diagnose the complications after renal transplantation, which plays a pivotal role in lowering the risk of renal graft and enhancing the survival of recipients and renal graft.