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Renal allograft thrombosis is the leading cause of graft failure in pediatric transplant recipients in the early post-transplant period. Various factors at multiple levels- donor, recipient, surgical and therapy-related, come into play in contributing to this risk. While early detection and intervention are keys in limiting the adverse effect of graft thrombosis on graft survival, preventative strategies have the most to offer in reducing morbidity related to this devastating complication. This article reviews the epidemiology, risk factors, diagnostic and therapeutic modalities to assist the clinician in taking care of children who are in the process of receiving renal transplants. The authors also address various strategies to screen for and prevent thromboses in this population. Lastly, we identify gaps in our knowledge base related to allograft thrombosis, to bridge which, robust research is urgently needed.