Abstract Objectives: Despite increased use of diabetogenic immunosuppressive drugs and increased incidence of new-onset diabetes after transplant in renal allograft recipients, there are few case studies on the subject of de novo allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes. We sought to study the outcomes of allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes in patients with new-onset diabetes after transplant. Materials and Methods: We reviewed the case records of all new-onset diabetes after transplant patients who underwent graft biopsy for graft dysfunction from 1992 to 2010. We analyzed the clinical characteristics and outcomes of new-onset diabetes after transplant patients with de novo allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes. Results: Of the 1989 recipients, 421 patients developed new-onset diabetes after transplant and 26 underwent graft biopsy. Of the 26 patients, 9 had histopathologic evidence of de novo allograft diabetic nephropathy, and 17 had interstitial fibrosis/tubular atrophy without specific glomerular changes. The mean duration from transplant to developing novo allograft diabetic nephropathy was 115.2 months (range, 33-192 mo), and from developing new-onset diabetes after transplant to allograft diabetic nephropathy, was 109.66 months (range, 27-188.4 mo). Of the 9 patients with de novo allograft diabetic nephropathy, 3 died (33.3%), 2 reached end-stage renal disease (22.2%), and 4 remained stable (44.4%). Of the 17 with interstitial fibrosis/tubular atrophy, 2 died (11.7%), 5 developed end-stage renal disease (29.4%), and 10 remained stable on triple immuno- suppression and insulin therapy during follow-up (58.8%). Conclusions: De novo allograft diabetic nephropathy is a significant cause of graft and patient loss in renal allograft recipients who develop new-onset diabetes after transplant. Key words: New-onset diabetes associated with transplant, Renal allograft, Diabetic nephropathy, Outcomes Introduction Diabetic nephropathy accounts for the 40% to 50% patients with end-stage renal disease (ESRD). Approximately 20% of diabetic ESRD patients subsequently undergo renal transplant. 1 Chronic allograft dysfunction, death from cardiovascular causes and infection, and acute rejections are the leading causes of graft loss in diabetic renal allograft recipients. 2 Chronic allograft dysfunction is usually caused by ongoing chronic rejection, calcineurin inhibitor toxicity, hypertension, and recurrent or de novo glomerulonephritis. 3 Theoretically, 3 forms of allograft diabetic nephropathy (ADN) may appear, 1 that is transmitted with an affected allograft, another with recurrent allograft diabetic nephropathy in those diabetic ESRD patients who received an allograft from a nondiabetic normal individual, and third, a de novo allograft diabetic Outcomes of De Novo Allograft Diabetic Nephropathy in Renal Allograft Recipients Narayan Prasad 1 , Pallav Gupta 2 , Manoj Jain 2 , Dharmendra Bhadauria 1 , Amit Gupta 1 , Raj Kumar Sharma 1 , Anupama Kaul 1 Copyright © Başkent University 2013 Printed in Turkey. All Rights Reserved. From the 1 Department of Nephrology and 2 Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Pin, India, 226014 Acknowledgements: The author states that he has no conflicts of interest to declare, and that he received no funding for this study. Corresponding author: Narayan Prasad, Additional Professor, Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Pin, India, 226014 Phone: +91 522 266 8606 Fax: +91 522 266 8017 E-mail: narayan.nephro@gmail.com; narayan@sgpgi.ac.in Experimental and Clinical Transplantation (2013) 3: 215-221 DOI: 10.6002/ect.2012.0193 ArtIcle