Despite limited outcomes data, kidneys from diabetic donors are being increasingly used in the USA. To compare outcomes in recipients of kidneys from diabetic versus non-diabetic donors, we performed a retrospective study of patients transplanted 3/11/ 1994-12/31/13, using registry data from the United Network for Organ Sharing. Survival analysis was modeled using cox regression. There were 9,074 recipients of diabetic donor kidneys and 152,555 recipients of non-diabetic kidneys. Allograft failure (HR 1.30, 95% CI 1.25-1.36, p < 0.001) and death (HR 1.17, 95% CI 1.11-1.22, p < 0.001) were increased in recipients of diabetic donor kidneys versus non-diabetic donor kidneys. Recipients age 40 and younger who received diabetic donor kidneys had an increased rate of allograft failure (log rank p < 0.001) compared to recipients > age 40 who received non-diabetic donor kidneys. Diabetic donor kidneys are associated with increased mortality and allograft loss compared to non-diabetic donor kidneys. These findings have the greatest implications for younger and non-diabetic recipients, who should be counseled on the risks of accepting diabetic donor kidneys.

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