Renal transplantation is established as the preferred form of renal replacement therapy as it improves quality of life and usually increases longevity. Unfortunately, owing to excessive co-morbidities, only 30% of patients who develop end-stage renal failure are fit enough to be listed for transplantation. Early attempts at kidney transplantation were blighted by immunological rejection, but the advent of potent immunosuppressive agents has raised 1-year graft survival rates to >90%. This success is also attributable to improvements in histocompatibility testing, organ procurement, preservation methods and perioperative care.