Since the first kidney transplantation was performed in 1976, 4,306 renal transplantations have been performed at Shanghai No. 1 People's Hospital and Fujian Oriental Hospital. Nearly all (99%) of the grafts were from deceased donors. Graft survival rates in the era of modern immunosuppression and HLA-based organ allocation have improved substantially. The one-, 5- and 10-year graft survival rates for 2,575 transplants performed during 1995-2004 were 93.9%, 71.8% and 53.9%, respectively. Chronic rejection accounted for 54.3% of graft failures and 54.2% of patient deaths resulted from graft failure. We performed 48 combined liver-kidney transplants since 2001 and the first simultaneous human islet-kidney transplantation last year.