Renal transplantation is the treatment of choice for most patients with end-stage renal disease, the incidence and prevalence of which is increasing in many developed countries. Despite a large increase in kidney donation by living donors over the last 10 years, a shortage of transplantable organs remains a major problem. Fortunately, over the same period, rates of acute rejection have fallen, and transplanted kidneys are surviving longer. In this article, Magee and Pascual discuss strategies to reduce the organ shortage and review the advances in immunosuppression, which have contributed to better kidney transplant survival. As early posttransplant outcomes are now so good, there is more emphasis on the prevention and treatment of long-term complications of transplantation such as cardiovascular disease, neoplasia, and bone disease. A multidisciplinary approach is thus needed to optimize long-term outcomes in renal transplant recipients.