Renal transplantation (RT) recipients are at a high risk of developing tuberculosis (TB) following transplantation especially in developing countries, with high incidences of morbidity and mortality. In this report, we study the risk factors and impact of TB on the outcome of kidney transplantation. Of 1350 live-donor kidney transplantations (1989-2005), 52 (3.9%) patients developed posttransplant TB. Of these, 7 had had TB pre-transplantation and 40 were male. The mean age was 32.6 ± 10.5 years. Primary immunosuppression treatment for all patients was cyclosporine (CsA). The mean time interval between transplantation and TB diagnosis was 54.6 ± 50.34 (range 4-140) months. In 65.6% of patients, TB was diagnosed one year post-transplantation. Pleuropulmonary TB was the most common form (63%). All post-transplant TB patients received a quadriple anti-tuberculosis therapy (Pyrazinamide, rifampicin, ethambutol and INH). Hepatotoxicity was seen in 16 patients, twelve were mild with normalization after temporary withdrawal of INH and rifampicin, and four cases were severe, but mortality was not attributable to hepatocellular failure. Twelve patients (23%) died. Chronic rejection occurred in 65% of the patients. More than 35% of TB patients lost their graft as a result. Pre-transplant tuberculosis patients had a comparable post-transplant course. TB is a common infection in renal transplant recipients with a peak incidence occurring one year post-transplant. Chronic rejection is a serious complication that had a negative impact on the graft survival. The post-transplantation outcome in the pre-transplant tuberculosis patients is no different from non-TB patients.