From Jan. 1968-Dec. 1981, 470 uremic diabetic patients received primary renal allografts. Until 1979, the patient and graft survival rates were lower in diabetic than in nondiabetic recipients. Since 1979, the results in diabetics have been at least equal to those achieved in nondiabetic patients. Two-year actuarial patient and graft survival rates in diabetic renal allograft recipients were, respectively, 71 and 66% from 1968-1976 (n = 156), 78 and 64% from 1976-1979 (n = 187), and 88 and 82% from 1979-1981 (n = 127). Improved survival rates were seen in all donor source and recipient age categories. For comparison, the 2-yr patient and graft survival rates in nondiabetic renal allograft recipients who received transplants between 1979-1981 (n = 162) were 92 and 79%. Changes associated with improved survival rates included performance of pretransplant splenectomy on all patients except those receiving grafts from HLA-identical siblings, deliberate transfusions of blood from .gtoreq. 5 random donors at least 1 mo. before transplantation, intensive insulin therapy for diabetic management post-transplant, and less vigorous treatment of repetitive rejection episodes. Diabetic recipients are no longer at higher risk than nondiabetics for graft or patient loss, at least during the 1st 2 yr after transplantation.