Background: Many factors and events can complicate the outcome of renal transplantation and can eventually lead to progressive renal dysfunction and graft failure. We aimed in this study to identify the risk factors for the entire course after transplantation, and then analyzed the relative impact of these risk factors on short and long term graft survival in our patients.Methods: an analytical retrospective study that was conducted at the King Fahd Unit, Faculty of Medicine, Cairo University on 282 patients who underwent renal transplantation between 1976 and 2010 with a minimum follow-up period of one year, though 43 patients were followed-up for three years. Serum creatinine was used to evaluate the renal function; graft dysfunction was defined as serum creatinine more than 2.5 mg\ dl. The following variables were recorded for each patient: gender, age at transplantation,BMI, pretransplantation period,pretransplantation treatment modality,causes of end stage renal disease, (HCV),graft source,immunosuppressive treatment protocols,mean serum creatinine ,post transplantation complications and mortality. Survival analysis was analyzed by Kaplan-Meier survival curve estimation. To predict the value of graft survival after 5 years, the regression analysis was used. Results: 68.1% of our patients were males and 39.9% were females in their second and third decades of life. In our study, the overall graft survival rates were 88.6% and 76.7% at one and three years respectively. The corresponding overall, patient survival rates were 87.6% and 79.1% at the first and third post-transplant years. Our study showed that among the long list of predictors for graft outcome variables, factors that had a significant impact on outcome by Kaplan- Meier analysis included donor’s age, primary immunosuppression, serum creatinine one month post transplant. There was a greater rate of graft dysfunction with the presence of HTN, HCV, and long pre-transplantation dialysis period with more blood transfusion. But these results did not reach statistically significant values.Conclusions: Old donor’s age, primary immunosuppression, serum creatinine one month post transplant are the most effective factors on graft survival in kidney transplantation. Whatever the cause of graft dysfunction, non-specific accelerating factors, such as hypertension, CMV infection, glucose intolerance, proteinuria etc., should be treated early and aggressively.