Immunosuppressed organ transplant recipients are more susceptible to cancer than are persons in the general population. If malignancies of the skin are excluded for geographic variation, a cancer incidence of 4% to 7% in transplant recipients is usual.We aimed to find the incidence, histopathological types, and outcome of malignancy in kidney transplant recipients in Kuwait.Between 1972 and October 2004, more than 1500 kidney recipients were followed. After excluding recipients who left the country soon after transplantation, we reviewed the medical records of the remaining 1171 kidney recipients (724 male and 447 female patients of ages 3 to 76 years) at the time of transplantation. Kidney grafts were obtained from 968 living and 203 deceased donors. Records were retrospectively reviewed for the incidence, clinical presentation, histopathological patterns, and outcome of cancer.Fifty-six malignant lesions (4.8%) were diagnosed in 51 recipients (28 men and 23 women, aged 15 to 66 years), who had received grafts from 44 living and seven cadaveric donors. Malignancy was diagnosed 4 to 288 months after transplantation. The most commonest types were posttransplantation lymphoma and Kaposi's sarcoma. Posttransplantation cancer presented earlier in female and in adult recipients and following decreased donor transplantation. Kaposi's sarcoma appeared earlier than posttransplantation lymphoma or squamous cell carcinoma. Less than 40% of recipients with malignancy are alive.