Abstract Objective: To determine patterns of weight gain after renal transplant. Design: A survey of a consecutive sample of renal transplant recipients evaluated at day 0, day 14, 3 months, and 6 months after transplant for weight changes. Gender; race; donor type; presence of diabetes as etiology of renal disease; response to glucose load at 1, 3, and 6 months; rate of rejection or infection; and lipid changes were compared. Patients: Fifty consecutive renal allograft recipients: 11 living related donor (LRD) recipients and 39 cadaver donor (CAD) recipients. Mean age was 40 years for LRD recipients and 39 years for CAD recipients. Setting: A university hospital-based solid organ transplant center with a renal transplant history of approximately 80 transplants/yr. Main outcome measure: Amount of weight gained. Secondary outcomes: (1) factors affecting amount of weight gained (ie, gender, race, presence of diabetes as etiology of renal disease, and donor type) and (2) factors affected by amount of weight gained, ie, response to glucose load after transplantation and lipid changes after transplantation. Results: Mean weight gain at 6 months for all recipients was 4 kg ( p < .0001). However, 30% either did not gain weight or lost weight during the 6-month period (4 women and 11 men), and these recipients had more rejections or infections. Recipients of LRD allografts gained 6 ± 2 kg (mean ± standard error of the mean), and those with CAD allografts gained 4 ± 1 kg (no difference). Women were above ideal body weight (IBW) at baseline (weight 62 kg; IBW 55 kg). Men were not different from IBW at baseline. Weight gain occurred in 76% of women (mean, 8 kg) and only 60% of men (mean, 7 kg). Women gained weight independent of their IBW at baseline, but men exhibited negative correlation of weight gained and percentage of IBW. There was no difference in weight gained between diabetic (mean, 5 kg) and nondiabetic patients (mean, 4 kg). No correlation for weight gained at 6 months and renal function was found. Conclusion: Early intervention for female renal transplant recipients is recommended because their baseline body weight is above IBW. Further evaluation of effects of weight gain after renal transplant according to recipient factors is necessary to establish appropriate protocols for control of weight gain.