Post transplant diabetes mellitus (PTDM) is a serious complication effecting the morbidity and mortality of kidney transplant patients. Immunosuppressive medication, i.e., cyclosporine, tacrolimus and steroids, play major roles in developing glucose deregulation and PTDM. Weighing immunosuppression toxicity and efficacy to prevent allograft rejection, still remains the main challenge facing the transplant community today. In this study we tried to evaluate the incidence and prevalence of PTDM in our transplant patients, and to determine risk factors for developing PTDM, and its effect on patient and graft survival. Retrospectively we analyzed 1718 patients that were transplanted at our center between January 1996 and December 2002. There were 438 pre-transplant diabetic patients who were excluded from the study, 246 patients developed PTDM (19.3%), cadaveric donor (68.1%), living donor (31.9%), with a mean follow up of 35+/-22 months. ANOVA, T-test and Kaplan Meier were used for analyses. The prevalence PTDM was 19.3%, with incidence at one year 17.5%, 3 years 6.7% & 5 years 6.4%. The risk factors for developing PTDM was age>55yrs. (p=0.001), Hispanic and African American vs Caucasian (p=0.04), overweight BMI>27 (p=0.001), high cyclosporine level (p=0.01), cadaveric donor transplant (p=0.03), mismatches>3 (p=0.04), & tacrolimus (p=0.04). Patient survival at 1 and 5 years was 97.9% & 96.2% respectively in non-diabetic vs 94.4% & 85.0% in PTDM group (P=0.001). Graft survival at 1 and 5 years was 95.6% & 83.3% in non-diabetic vs 84.7% & 70.9% in PTDM group (P=0.001). The prevalence of PTDM in our patients was 19.3%, with incidence of PTDM 17.5% at 1 yr, 6.9% at 3 yrs., and 6.4% at 5 yrs. Patient and graft survival were statistically significantly lower in the diabetic group. High risk donor and recipient profile is associated with high incidence of PTDM when heavy immunosuppression or induction therapy was used.