We evaluate the incidence of acute rejection, opportunistic infections and non-dermatological malignancies, graft and recipient survival between a group of high immunological risk renal transplant recipients and a group of patients without immunological risk, who received grafts from the same cadaveric donors since 2001 to 2006. This is a prospective and observational study. The risk group (n= 50) included patients with high rate of antibodies (> 50%), recipients who had lost their first graft due to early rejection, cross match positive, black race or important histoincompatibility. They received thymoglobulin to maintain T-cell around 10 cells/ microl, FK 506 after five days, mycophenolate mofetyl and steroids, with ganciclovir prophylaxis for CMV. The normal risk group (n=50) ,cyclosporine, mycophenolate mofetil and steroids. Recipients who lost their graft due to technical failure were excluded..All CMV seronegative recipients who received seropositive grafts were treated with valganciclovir for 100 days.The mean follow-up was 42,7 months. Both groups were similar respect to donor and recipient gender and age, HLA incompatibility, but the percentage of patients with high rate of performed antibodies and second transplant recipients was higher in the high risk group according to the criteria of the study The incidence of acute rejection histologically diagnosed was higher in the normal risk group (30% against 6 %, p=0.03). There was no difference in opportunistic infections or malignancies, although 2 recipients of the normal risk group developed lymphoproliferative disorders. The recipients survival was 97,9% at 1 and 3 years in both groups, and the graft survival was 89,8% and 84,8% in the high risk group against 93,8 % and 90,4% at 1 and 3 years in the normal group (p=NS). We conclude that the evolution of high risk renal transplant recipients is similar to normal risk patients if a potent enough immunosuppression is used. The incidence of acute rejection was higher in the normal risk group.