Renal Transplantation is the optimum therapy of end-stage renal disease (ESRD) patients. Transplant registry is quite essential in determining the different factors that may influence the success, failure and long term outcome of a transplant program. Our registry has been established in early 1980s. A specific registry book was created to include the name of patient, age, sex, nationality, diagnosis of ESRD, date of starting dialysis, type and date of kidney transplantation and post transplant follow up. We retrospectively analyzed our registry from 1978-2006. There were 231 post kidney transplant patients (68% males and 32% females); about 15% of the total ESRD patients that have been on dialysis. Currently, 31% are in active follow-up, 44% moved to other renal units, 17% went back on dialysis and 8% died. The source of the graft in 67% of cases was from live unrelated donors, 13% from live related donors and 20% from cadaveric donors. Out of the total recipients 76% where Saudi and 24% non-Saudi, 28% performed in the kingdom of Saudi Arabia and 72% abroad. The median age was 46 years (19-80) and duration of follow-up was 8.4 years (1-28). The blood group was O+ in 44%, 26% A+ and 18% B+. The majority of patients (62%) were negative for HCV and HbsAg, 32% HCV positive, 5% had HBsAg+ and 1% positive for HBsAg and HCV. All patients were HIV negative. The immunosuppressive regimen was: 0.5% on prednisolone alone, prednisolone and azathioprine 2%, prednisolone and cyclosporine 12%, prednisolone, cyclosporine and azathioprine 62.5%, cyclosporine and mycophenolate mofetil in 23%. Mean serum creatinine in the active group was 1.8 mg/dl (0.6-5.9). There were five patients (4%) treated for reactivation of tuberculosis, 1% developed CMV infection and 3% developed different post transplant malignancies. Post transplant diabetes mellitus and hypertension accounted for 40% and 60% respectively. In conclusion, early analysis of our registry shows that only minority of our dialysis patients managed to get transplanted. Most of those transplanted were males and the majority performed abroad from live unrelated donors. The most immunosuppressive regimen was the combination of prednisolone, cyclosporine and azathioprine; though some patients are still on prednisolone alone or with azathioprine with normal graft functions. Post transplant infection rate was relatively low, but the major complications were hypertension and diabetes mellitus.