While excellent organ quality and ideal transplant conditions eliminate many of the know factors that compromise initial graft function (IGF), poor early graft function (EGF) still occurs after living donor kidney transplantation (LDKT). Hyper calcemia and hyper parathyroidism are associated with impaired renal function. Little is know on the effects of serum calcium level on poor EGF. The aim of our current study was to determine the effects of serum calcium and PTH level on poor EGF. Between April 2004 and January 2006 data were collected on 353 (302 male, 52 female) LDKT to determine risk factors for poor EGF, defined as either delayed or slow graft function (DGF or SGF). Recipients were analysed in three groups, based on initial graft function (IGF) (creatinine <3mg/dl 5day after transplantation, SGF (creatinine>3mg/dl 5day after transplantation and DGF (need for dialysis in the first week post-transplant). A multivariate analysis looked specifically at pretransplant serum calcium, phosphate,calcium-phosphate product, PTH and use of calcium blockers for IGF,as compared with SGF and DGF RESULTS: Of the 353 recipients, 317 (89.8%) had IGF, 22 (6.2%) had SGF and 14 (3.9%) had DGF. diabetic etiology of renal disease (p=0.09) and duration of dialysis (p=0.02) associated with poor EGF. recipient with DGF had higher serum phosphate (p= 0.007), calcium phosphate product (p=0.01)than recipients with IGF and SGF. PTH in recipient with SGF and DGF was higher but not significant (p=0.1). Serum calcium level (p=0.9) did not with the occurence of poor EGF, and use of calcium channel blockers has not a protective effect. In this study we conclude that serum phosphate calcium phosphate product as a risk factor for DGF, and PTH level as a risk factor for SGF and DGF may be considered. We cannot find correlation between calcium level and poor EGF, also use of calcium blockers cannot reduce the risk. Efforts to improve calcium phosphate–PTH homeostasis in patients on the waiting list of renal transplantation should be encouraged also to improve graft function.