Seven patients with dialysis dementia are described. Three patients, symptomatic from dementia at the time of transplantation, had a rapid exacerbation of their symptoms with deterioration to death. Four patients, asymptomatic at the time of transplantation, developed symptoms of dementia after surgery. Two of these had a rapidly fatal illness while the remaining two had a mild illness. One subsequently died from a myocardial infarction while the other gradually improved sufficiently for her to return to work. This experience indicates that transplantation is to be avoided in patients with dialysis dementia.