Although short-term kidney graft survival has improved in recent years, the focus has shifted to the challenge of improving long-term graft survival. Acute rejection, chronic allograft nephropathy, and cardiovascular disease are associated with graft loss and patient death. Reducing the potential for such posttransplantation complications may improve long-term graft survival. In addition, gaining a better understanding of the role that various immunosuppressive therapies have in decreasing the risk for graft injury will help clinicians make better-informed decisions about appropriate treatment regimens for individual kidney transplant recipients.