Thrombotic microangiopathy (TMA) after kidney transplantation is a rare but serious complication characterized by microangiopathic hemolytic anemia, thrombocytopenia and graft dysfunction. It is an important cause of both graft loss and recipient death. The etiology of TMA after kidney transplantation is complex, encompassing calcineurin-inhibitor toxicity, antibody-mediated rejection, infection and drug factors. In recent years, with the in-depth understanding of the core role of the complement system in TMA after kidney transplantation, the application of complement C5 inhibitors (such as eculizumab and ravulizumab) has completely changed the treatment landscape and prognosis of this disease. Therefore, this article aims to provide a systematic review of the progress in the diagnosis and treatment of TMA after kidney transplantation based on the latest literature in recent years, from the aspects of etiology, diagnosis treatment and prognosis, in order to provide a reference for the clinical management of TMA after kidney transplantation.