We analyzed the impact of prior vascular disease on the outcome of renal transplantation in 99 insulin-dependent diabetic patients. Thirty-three patients (group A) had clinical evidence of vascular disease prior to renal transplantation and 66 patients (group B) had no clinical vascular events in the pretransplant period. The median follow-up in group A patients was 14 months and in group B it was 23 months. The group A patients with preexisting vascular disease had a significant increase in mortality (33%) compared to group B (11%) (A vs. B; p = 0.01). The rate of graft loss was not significantly different between the two groups (45 vs. 42%; p = 0.94). Our data suggest that preexisting clinical vascular disease has a significant negative effect on patient survival in diabetic recipients of cadaver kidney transplants.