Background: Patients who have received renal allografts experience early aging of the skin, opportunistic infections, and an increased incidence of skin cancer. Objective: We compared the density of lymphocyte subsets and Langerhans cells in normal-appearing skin of renal allograft recipients without skin cancer at 5 to 6 years (group 1) and 14 years after transplant (group 2) with a matched normal control group. Methods: Biopsy specimens of sun-protected and exposed areas from 18 white, kidney allograft recipients (10 in group 1 and 8 in group 2) with normal renal function and from 10 healthy volunteers were semiquantitatively analyzed for dermal lymphocyte subsets and Langerhans cells. Results: There was a statistically significant decrease in all dermal cell elements in the sun-protected skin of both groups of patients who had received grafts. The sun-exposed skin of group 2 also showed a significant decrease of dermal CD4⁺ and CD8⁺ lymphocytes, and group 1 had a significant decrease in dermal CD8⁺ lymphocytes. The dermal CD1a⁺cell population in the sun-exposed skin from both grafted groups did not differ from the control group. Conclusion: Kidney transplant recipients showed dermal depletion of cells related to immune surveillance against tumors even before skin cancer occurred, and this depletion seemed to become more marked with the duration of immunosuppression. (J Am Acad Dermatol 1998;38:38-44.)