[Renal transplantation.]

Renal transplantation is the treatment of choice for most patients with end-stage renal disease. The improved success of this treatment modality over the past four decades can large part be attributed to advances in immunosuppressive therapy. However, while the demand for renal transplantation has been steadily growing due to the rising incidence of end-stage renal disease, shortage of organ donors is a major limitation. The shortage of kidneys for transplantation has been met with an increase in the use of living donors. Renal allograft survival has improved over the years, although late graft loss is still a significant problem. One and five-year survival of living donor grafts is approximately 94% and 72%, and 88% and 60% for cadaveric donor grafts, respectively. The main causes of late graft loss are death of the patient and chronic allograft nephropathy. Risk factors for chronic allograft nephropathy are complex and include both immunlogic and non-immunologic mechanisms. Finally, the results of renal transplantation in Icelandic recipients are discussed.