Although remarkable improvements in short-term survival of renal transplants have been made, long-term outcomes are still disappointing. Over the last few years, recent developments in the field have altered our concepts of why transplants fail and hopefully will lead to newer therapies to prolong long-term function and survival. This talk will address the latest literature on the issue of long-term survival and take a critical view of both the insights gained and the issues that still need to be addressed. Dr. Bruce Kaplan is chief of nephrology and medical director of the Abdominal Transplant Program at University Medical Center.