Post transplant diabetes mellitus (PTDM) has been identified as one of the most dangerous risk factors for graft and patient survivals after kidney transplantation. The aim of this retrospective study is to estimate the incidence, risk factors, complications and impact on graft and patient survivals among Egyptian live-donor renal allograft recipients. Among 1580 kidney recipients performed between March 1976 and May 2004, 286 recipients (18.2%) had PTDM. A group of 316 normoglycemic recipients was served as a control group. Both groups were homogenous regarding gender, donor characteristics, HLA matching and time of transplantation. The onset of PTDM in the majority of our patients (52.4%) was within the first 6 months posttransplant. Multivariate regression analysis revealed that the significant risk factor for development of PTDM were older recipient's age, positive family history, increased body mass index, total steroid dose in the first 3 months post transplant, the use of calcineurine inhibitors and HCV infection. A statistically significant (P = < 0.05) higher incidence of coronary heart disease, post transplant hypertension, proteinuria, hyperlipidemia, retinopathy, recurrent infections, neuropathy and strocks were encountered among PTDM recipients. While the graft survival was comparable in both groups, the patient survival was significantly lower among the PTDM recipients, and cardiovascular events were the leading cause of death. In conclusion, although graft survival was not significantly affected, PTDM is adversity affecting the patient outcome.