OBJECTIVE To present data on cancer distribution in renal-transplant recipients in Chinese people, as in Western studies renal-transplant recipients are reportedly at greater risk of malignancies, especially skin cancer, but there is limited information in Chinese people. PATIENTS AND METHODS Using the data of a cancer registry, we compared a hospital-based cohort of 283 renal-transplant recipients between 1981 and 2002 with the general population in Taiwan, to identify the incidence and risk factors of cancer. RESULTS The cumulative period of observation was 22 582.93 person-months. Twenty-five patients (8.83%) developed malignancies after renal transplantation; the standardized incidence ratio was 4.6 (95% confidence interval 2.84-6.48). Bladder and renal cancers were commonest, and the cumulative incidence rate (CIR) was 4.59%. The second most frequent type was hepatoma, where the CIR was 1.77%. The third was malignant tumour of the skin, with a CIR of 1.41%; these comprised three Kaposi's sarcoma and one malignant lymphoma, with no incidence of squamous or basocellular skin cancer. CONCLUSION Compared with Western countries, the distribution pattern of cancer after kidney transplantation was different, with no squamous or basocellular skin cancers, and a very high incidence of kidney and urinary tract cancer.