 Several conditions may lead the worsening of the diabetes after transplantation. First, for patients with ESRD the improvement of kidney function after kidney transplantation leads also to an increased clearance of circulating insulin. Second, most patients experience a significant improvement of well being after successful transplantation. Often their appetite is significantly improved, resulting in a significant weight gain - increasing insulin demand and resistance. Finally, most immunosuppressive medications are diabetogenic. Corticoid-steroids are well known for their strong diabetogenic effect and have been associated with post transplant diabetes. Calcineurin inhibitors are now the corner stone of immunosuppression for organ transplantation. This class of medication includes cyclosporine and tacrolimus. Both have been associated with post transplantation diabetes. Induction agents, including polyclonal antibodies ex. Thymoglobulin and monoclonal antibodies ex. Anti Il-2 receptor, Zenapax, Simulect are not found to cause hyperglycaemia. The two areas of possible intervention to minimize worse diabetes after transplantation are thus limited to 1 comprehensive diabetes education and 2 newer immunosuppressive regimen after transplantation. 