One of the critical factors in solid organ transplantation is the assessment of graft status and viability as well as stringent monitoring of transplant recipient. The evaluation of ischemic damage after preservation and transplantation is essential for the prediction of graft changes in the early phase and the management of the immunosuppressive therapeutic particularly for the nephrotoxic drugs. In addition, this assessment could influence the long-term graft survival because injury during the transplant process affects the alloantigen-independent processes of chronic graft dysfunction (CGD). Nuclear magnetic resonance (NMR) spectroscopy is a non-destructive and non-invasive technique that can detect and quantify low molecular weight metabolites in biological fluids such as plasma and urine. Recently, different experimental and clinical studies have highlighted the potential role of NMR spectroscopy in the evaluation of different parameters and metabolic response of living systems to pathophysiological stimuli. NMR spectroscopy has been studied in the evaluation of variations in different metabolites which could contribute to prognosis and diagnosis of graft function impairment related to cyclosporine toxicity or overdosage. Thus NMR spectroscopy should improve the follow-up and management of transplanted patients and the assessment of graft status.