Renal transplantation for terminal renal failure as a result of scleroderma (progressive systemic sclerosis [PSS]) seems justified if other organs have not been severely damaged by the disease. The recurrence of PSS in the graft, not observed in early reports, appears to have caused the rapid failure of a cadaveric graft in a forty year old woman with acute PSS. A similar case of rapid PSS recurrence in the transplant has been recently reported by others [7]. A more aggressive pattern of PSS seems to differentiate these two patients in whom recurrence was observed from four previous patients with long-term graft functions. The possibility of rapid renal transplant loss should be considered in the selection and prognosis of acute PSS patients.