Abstract Background and Aims The worldwide incidence of PTDM ranges between 2.5% and 20%. Although there is a good knowledge of PTDM pathogenesis, there is still uncertainty about its proper long-term management. DR, DKD and DSPN are microvascular complications frequently seen in type 1 and 2 DM. Few data are available regarding these complications in patients with PTDM. It remains unclear if the progression of chronic diabetic complications in transplant recipients is similar to that of patients with other types of diabetes. The study was conducted to assess micro-vascular complications in renal transplant recipients with ≥5 years duration of PTDM Method This is a retrospective and prospective observational study of PTDM patients conducted between November 2018 to December 2020, at a tertiary care hospital. All renal transplant recipients on follow up at the institute with ≥ 5 years duration of PTDM were included in the study. Patient characteristics and laboratory values were noted from patient files and electronic records. Fundus evaluation was done by direct ophthalmoscopy. If graft kidney biopsy was done for clinical indications, it was included in evaluation. DSPN was assessed through MNSI and 10-g Semmes-Weinstein monofilament examination. Results 115 patients with PTDM duration ≥ 5 years were included in the study. Mean PTDM duration was 8.7 ± 3.0 years. None presented findings of diabetic retinopathy at fundus examination by direct ophthalmoscopy. 37.4% patients had DSPN which was associated with PTDM duration (p value < 0.03, 95% CI, 1.53 to 29.17). The mean eGFR was 59.2 ± 21.8 ml/min/1.73 m 2, 53.9% patients had eGFR ≥ 60 ml/min/1.73 m2. 35.7% patients had proteinuria ≤ 300 mg/day. 23 (20%) patients with PTDM duration ≥ 5 years underwent graft kidney biopsy, 4 biopsies were reported as de-novo DKD, 6 biopsies were reported as suggestive of DKD. The patients with DKD had mean PTDM duration of 143.3±52.4 months, mean eGFR 44.8 ±21.8 of and a median proteinuria of 2653 mg (IQR 2758). In secondary analysis of the 23 biopsied patients PTDM duration was associated with DKD development (p value = 0.03, 95% CI, 0.93 to 0.99). Conclusion The initiation of microvascular complications does not seem to be as accelerated as previously supposed. DR may not be as strongly associated with de-novo DKD in PTDM patients as seen in type 1 and type 2 diabetes mellitus. PTDM seems to be a unique type of diabetes, and its consequences may be milder than expected in type 1 and type 2 diabetes.