The advanced glycation end-product, pentosidine, was measured in plasma proteins and skin collagen before and after kidney and kidney-pancreas transplantation in order to determine the relationship between plasma and tissue levels and to characterize the pattern of change in pentosidine levels after correction of hyperglycemia and/or renal failure. The content of pentosidine in skin collagen was higher than that in plasma proteins both before and after transplantation. However, there was no correlation between plasma and skin pentosidine levels. Prior to transplantation, the content of pentosidine in skin collagen was related to the duration of dialytic therapy, presence of diabetes mellitus, age, and female gender. Following transplantation, plasma pentosidine levels were inversely correlated with glomerular filtration rate (r = 0.64; p < 0.01). While plasma pentosidine levels consistently decreased after transplantation, levels in skin collagen increased in 10 of 13 patients, including 5 of 6 recipients of kidney-pancreas transplants. Our results indicate that tissue levels of pentosidine persist for long periods of time after kidney or kidney-pancreas transplantation, despite consistent decreases in levels measured in plasma proteins. The observed increase in tissue pentosidine levels in a majority of patients suggests that formation of advanced glycation end-products may continue after otherwise successful kidney or kidney-pancreas transplantation.