1. One-year graft survival rates for recipients of cadaver kidney transplants improved from 75% in 1988 to 83% in 1991 (p < 0.001). The one-, 5-, and projected 10-year graft survival rates for cadaver donor transplants performed in 1991-1995 were 84%, 60%, and 43% respectively. 2. One-year graft survival rates for recipients of living donor transplants also improved from 89% in 1988 to 93% in 1991 (p < 0.001). The one-, 5-, and projected 10-year graft survival rates for living donor kidney transplants performed in 1991-1995 were 92%, 75%, and 62% respectively. 3. Diabetic patients received one-quarter of the cadaver kidneys transplanted from 1991-1995 and one third of diabetic patients received a simultaneous pancreas (SPK) transplant. One- and 5-year graft survival rates were 81% and 54% for diabetics receiving a kidney transplant and 85% and 67% for SPK recipients, respectively. Patient survival was 10% lower for recipients of a kidney only transplant. 4. Sensitization to alloantigens, whether by pregnancy, transfusion, or graft failure resulted in about a 5% increased risk of early graft failure. Patients who developed broadly reactive anti-HLA antibodies before their first transplant had the same 5-year graft survival rate (60%) as unsensitized patients. Retransplanted patients who had not developed broadly reactive antibodies also had a 60% 5-year graft survival rate, compared with 50% for those with > 50% PRA. 5. Blacks received one-quarter of cadaver kidneys transplanted in 1991-1995. The one-year graft survival rate for Black first transplant recipients was 83% compared with 84% for Whites. After the first year, the graft loss rate among Blacks was almost double that for other racial groups (5.8 year half-life vs 11.3 years for Whites, p < 0.01). The 5-year graft survival rate was 49% among Blacks and 63% for Whites. Asian recipients had the highest one- and 5-year graft survival rates (89% and 70%, respectively). 6. Shared kidneys had a longer average cold ischemia time (30 hr) than kidneys transplanted locally (21 hr). Fewer than half of shared kidneys were transplanted to HLA-matched recipients. The 5-year graft survival rate for shared kidneys with zero or one HLA antigen mismatched was 68% compared with 59% for shared kidneys with more than 3 antigens mismatched and for locally transplanted kidneys (p < 0.001). 7. The distribution of living donor relationships has changed substantially. When comparing transplants performed in 1988-1989 with those performed in 1994-1995, the number of living donor transplants increased by 80%, the fraction of offspring-to-parent grafts increased from 9-15%, the fraction of genetically unrelated donors increased from 4-10%, and the fraction of distant relatives increased from 2-6% of the living donor transplants. 8. The results of living donor transplants generally followed the degree of HLA compatibility. The one-year survival rate for HLA-identical sibling grafts was 96%, followed by 92% for one-haplotype matched sibling, parent and offspring donor transplants, 90% for unmatched sibling donors and 88% for spousal donors. Other unrelated donor transplants had a slightly higher one-year graft survival rate of 92%, which was more similar to the one-haplotype matched grafts.