Recipients of multiple renal transplants pose greater immunological and technical challenge compared to the first time recipients. We studied our multiple transplants for the factors that might influence graft outcome in them. Data was collected of patients who received more than one transplant from 1993-2004 in our unit. Number of re-transplants, recipient age, donor age, donor type (cadaveric/living), HLA mismatches and recipient sensitization were noted. Graft survival was calculated by Kaplan-Meier and log rank test, and Cox regression hazard model was used for multivariate analysis.Among 197 (mean age - recipient 36+/-16; donor 40+/-16) patients who received multiple transplants, 163(83%) had 2 (Group 1), 25(13%) had 3 (Group 2) and 9(5%) had more than 3 transplants (Group 3). A total of 173 (88%) received kidneys from the cadaveric donors and 24 (12%) from the live donors. HLA mismatches were 2.2 +/- 1.5 and the mean PRA level was 43.3 +/- 40.0% Overall 68 grafts failed [53 (33.1%) in Group 1, 12 (48.0%) in Group 2 and 3 (33.3%) in group 3]. One and 3 year graft survival for respective groups were 85%, 75%, 75%; 66%, 77%, 75% (P=0.5). On multivariate analysis, only living donor transplantation independently correlated with better outcome (P=0.03). In patients with multiple transplants, number of re-transplants has an adverse effect on the graft outcome but the relationship between the two is not linear. Amongst other factors, living donor transplantation significantly improves graft outcome.