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Renal transplantation is well established as the treatment of choice for selected patients with end stage renal failure. A renal transplant recipient can enjoy an improved quality of life while benefiting from a reduction in the mortality associated with long-term dialysis. However, the success of transplantation is limited by the disparity between an ever growing demand for organs and an insufficient supply of organs. Expansion of the organ donor pool has been achieved through increased utilization of living donor kidneys in paired and domino transplant schemes, transplantation across HLA and ABO boundaries, as well as a greater acceptance and consideration of extended criteria allografts. While 1-year graft survival rates are significantly higher than a decade ago, the rate of chronic graft loss after the first year remains substantial. The surgical procedure can be challenging due to operating on recipients with multiple …