The factors that have led to a steady improvement of one-year renal allograft survival, have not resulted in better long-term outcome. Main causes of chronic renal allograft failure are patient death with a functioning transplant, chronic rejection and non-compliance with immunosuppressive therapy. The role of hyperfiltration as a cause of graft failure is at present unclear. Among the risk factors associated with allograft outcome are donor- and recipient characteristics, HLA matching, delayed graft function and acute rejection episodes. As with short-term results there are considerable differences between transplant centers. The effect of cyclosporine-based immunosuppression on late graft outcome is still controversial. Possibly, the potential benefit of cyclosporine is obscured due to suboptimal dosing in the fear of chronic nephrotoxicity.