As with other similar-sized programs across the country, kidney transplantation has evolved at the University of Pittsburgh. The shortage of organs represents the biggest problem, and in response there has been an increase in the number of live-donor and extended-criteria-donor transplants. Laparoscopic nephrectomy techniques have been widely used at our center with live donors, and have had a significant impact on the number of live-donor transplants. As the program has matured, we have seen an increasing number of recipients needing re-transplantation and patients with non-renal transplants who have progressed to ESRD and need a kidney transplant. This fact highlights the second major problem facing the field today: the morbidity associated with long-term immunosupression. Our program, along with others, continues to look at methods to minimize the overall amount of long-term immunosuppression to which patients are exposed.