AbstractThe practices and recent results from a transplant center servicing a large proportion of uremic diabetics were reviewed to highlight modern management issues. The focus is taken off the diabetic as a “high‐risk” renal transplant recipient and brought to bear on the laborintensive aspects of his or her management. With special attention to perioperative cardiovascular status, operative mortality (30 day) can be less than 3.5% and morbidity minimized. Living related donors continue to offer advantages in terms of organ availability, early postoperative function, and most likely long‐term function, but in the cyclosporin era cadaver renal transplants have evolved competitive 1‐year patient survival rates of 96% and 1‐year graft survival rates of 88%. Still, the proportion of graft losses due to death of the patient from nonimmunologic causes, chiefly cardiac and cerebrovascular events, remains relatively high in the diabetic at 35.8%. Rehabilitation of the diabetic post‐transplant is less complete than that of the nondiabetic transplant recipient, but is clearly superior to that of alternative modes of therapy for the uremic diabetic.