Renal transplantation is the best management for patients suffering from end-stage renal disease (ESRD). It has many benefits which overcome the complications of dialysis, it has some acute and long term complications that could result in failure. Failure of transplant is the fourth cause of death among patients with end stage kidney disease. The causes of failure is still a debate but rejection, drug toxicity and fibrosis as well as chronic allograft nephropathy and patient's immunity related factors. This review will provide important information regarding the causes associated with post-renal transplant failure.