Juvenile (type I) diabetes is currently the second most common cause of end-stage renal disease in the United States. Cadaveric renal transplantation has emerged as an important form of treatment for the uremic diabetic as graft and patient survival have steadily improved. Graft survival approaches that for nondiabetics, but mortality and morbidity from vascular complications continues to be a major problem, and in several series, patient survival is inferior to that in nondiabetics. Cyclosporine (CyA) is being used extensively in cadaver renal transplantation and has been shown to be superior to conventional treatment with azathioprine and prednisone. Nephrotoxicity remains a problem, however, and there may be an increased risk of primary nonfunction if CyA is administered immediately after transplantation. We have been using CyA as part of a quadruple-drug regimen for cadaver renal transplantation. In this protocol Minnesota antilymphoblast globulin (ALG) is used for initial immunosuppression and CyA administration delayed until renal function has stabilized. This regimen avoids the possible detrimental effects of CyA in an oliguric kidney. We have been able to achieve 95% patient survival and 90% graft survival in primary cadaver renal allografts using this protocol.