The experience with cerebromeningitis in recipients of 769 renal allografts occurring over a 20-year period has been reviewed. Eighteen patients developed this complication; an incidence of 2.7%. Clinical manifestations were often subtle, although fever occurred almost universally. Primary risk factors included diabetes mellitus, use of high dose steroids both as maintenance immunosuppression and as treatment for acute rejection, and coincident infections or complications. The responsible organisms were fungi; the overall mortality rate 44%. By recognizing individual patient types who are at potential high risk for this complication, earlier diagnosis and more prompt and aggressive therapy has diminished the mortality dramatically in the last several years.