In summary, the analysis of more than 270,000 kidney transplants recipients who were transplanted between January 1988 and August 2010 showed the following important points: Despite enormous progress in short-term graft survival in the last decades, long-term graft survival remained largely unchanged over the period from 1988 to 2010. The marked decline in acute rejection episodes in the early transplantation period mainly contributed to the improvement of shortterm graft survival. The immunosuppressive agents that were introduced in the past 3 decades have not improved long-term graft survival. Therefore, new treatment approaches are strongly required to prevent and treat chronic allograft injury especially caused by immunologic factors. Avoiding and controlling risk factors that are responsible for cardiovascular diseases are the sine qua non for increased long-term graft survival.