Infections after transplantation account for half the deaths that occur in this group of patients in India. The spectrum of infections, their chronological occurrence, and the risk factors are different from that of developed regions. The diagnostic and therapeutic protocols are adapted to the different medical and socioeconomic environment. Tuberculosis affects 10% to 15% of renal allograft recipients; the risk is twofold and fourfold greater in those with hyperglycemia and chronic hepatitis, respectively. Pretransplantation tuberculosis is predominantly located in the lymph nodes, whereas after transplantation, the disease is often disseminated and manifested earlier due to cyclosporine therapy. Gastric juice smears and cultures for Mycobacterium tuberculosis were found to be useful tests in this group. Primary drug resistance to this organism was a problem. Isoniazid prophylaxis offered some protection from tuberculosis but was limited in the high-risk population with hepatitis. The prevalence of deep mycoses was 3.8% to 6.1% and was associated with 70% mortality. Pneumocystis carinii pneumonia emerged after 1991. Nocardiosis occurred earlier in patients who received cyclosporine and was manifested frequently, along with tuberculosis and other infections. Chronic liver disease affected 30% of patients and caused 8% of deaths. It was an important comorbid factor in patients with serious infections. Hepatitis B virus was seen in 40% of patients and hepatitis C virus in 15%. Cytomegalovirus infection was found in 20% of patients. Plasmodium falciparum infected 22.5% of renal transplant patients in western India and produced acute renal failure in 60%. Most malignancies encountered in India have had a presumed viral origin. The pattern of infections changes as immunosuppressive protocols vary and as the use of hepatitis B vaccine, hepatitis C virus screening, erythropoetin, and chemoprophylaxis becomes the standard practice in India.