Significant progress has occurred over the decades in renal transplantation, mostly driven by improvements in short-term (one year) graft and patient survival. Further improvement, which has to come mainly from long-term survival improvements, has been more difficult to achieve.

The multifactorial nature of chronic renal allograft loss makes specific interventions difficult. In the absence of any good tools to individualize immunosuppression to each patient, modest progress has occurred in long-term graft attrition, resulting in longer kidney allograft half-lives.  An adequate immunosuppression regimen can decrease graft rejection rates. On the other hand, increased immunosuppression can lead to more graft loss driven by opportunistic infections.