OBJECTIVES: The introduction of recombinant erythropoietin (rHu-EPO) hasbeen shown to reverse anemia of chronic renal failure and was able to almost completely obviate the needfor repeated blood transfusions (BT), the most potent cause of allostimulation in renal transplant candidates.The series describes single center experience of the pretransplant BT and rHu-EPO therapy effects onlate outcomes of cadaveric renal transplantation. METHODS: We retrospectively analyzed data of 502 adultrecipients of primary renal allograft between 1990-1997 whose graft survived > 6 months. In the studygroup 51 patients were treated prior to transplantation with de novo rHu-EPO therapy, 207 patients receivedBT, 184 patients were switched from BT to rHu-EPO therapy, and 60 patients did not require treatment.The groups were compared in respect to pretransplant % PRA, frequency of acute rejections and graft survival.RESULTS: At one-year graft survival was similar between groups, however at five years recipients of denovo rHu-EPO and those who have converted from BT to rHu-EPO experienced only 7% graft loss, as comparedto 22% of patients treated with BT, and 18% of patients who did not require treatment, p < 0.001. Thepretransplant therapy with rHu-EPO was associated with decreased frequency of late episodes of rejectionfrom 0.42 to 0.27, p = 0.03. There were no differences between groups in the number of highly sensitized(PRA > 20%) at the time of transplantation. CONCLUSIONS: The use of rHu-EPO as de novo therapy or conversionfrom BT treatment to rHu-EPO prior to transplantation was associated with a decline in late posttransplantalloreactivity and improved late renal graft survival.