*Purpose: Our study aims to demonstrate the impact of diabetes, types I and II, on American young adults (18-40 years old) requiring kidney transplantation.

*Methods: Using the United Network for Organ Sharing database, we conducted a population cohort study which included all first-time, kidney-only transplant recipients during 2002-2019. Patients were grouped according to indication for transplant. Primary outcomes were cumulative all-cause mortality and graft failure. Graft and patient survivals at 1, 5, and 10 years were calculated via the Kaplan-Meier method. Multivariate Cox regression was used to assess for potential confounders.

*Results: Of 42,473 transplant recipients, 3,418 (8.1%) had end-stage kidney disease associated with diabetes. At each time-point, cumulative mortality and graft failure were higher in diabetics compared to patients with non-diabetic causes of renal failure. Adjusted hazard ratios for all-cause mortality and graft failure in diabetics were 2.96 (95% CI 2.65-3.31; p<0.01) and 1.26 (95% CI 1.17-1.35, p<0.01), respectively.

*Conclusions: This study demonstrates the vulnerability of young adult diabetic patients in the largest cohort of kidney transplant patients to date. Identifying the underlying causes of poor outcomes in this population should be a priority for future study.

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