Twenty-five years of transplant experience at Policlinico University Hospital of Milan.

1. CsA treatment played a major role in the improvement of renal transplantation in the third era of our experience for every class of recipient. Many of the most recent patients involved higher risks than in previous eras. 2. The type of donor (LD or CD) did not make a significant difference in patient or graft survival rates up to 4 years. However, the survival rate of LD kidney transplants was better in later follow-ups than that of CD transplants. Pediatric and older kidneys can be used safely, although a lower survival rate is achieved by these grafts. 3. The sex and the side (right or left) of the donor kidney does not affect the outcome of transplantation. 4. In both multiorgan and single-kidney donor origin, there was no difference in graft survival. As all MOD kidneys were flushed with UW Solution and all SKD kidneys were flushed with EC Solution, we can assume that there is no difference in graft outcome, whichever of these solutions is employed. 5. The limited availability of CD grafts has been overcome by using marginal kidneys and adopting extracorporeal microvascular techniques. The results compared well with those of normal allografts. 6. The transplant outcome is penalized by expected higher mortality in older patients. And in pediatric patients there is a higher rate of graft failure due to rejection. 7. Retransplanted grafts under CsA have a better success rate than those using conventional therapy. 8. Extrarenal pathology and the actual risk ratio for CsA-treated recipients still need to be defined by future follow-ups. 9. Our results in renal transplantation, particularly from CDs, could be defined as good in comparison to those of other large transplant centers. 10. The main problem remains that the supply of CD kidneys has decreased in recent years, whereas the demand is increasing, perhaps due to the opening of other transplant centers, an inadequate policy for organ procurement, and ineffective legislation, the last being essential to promote kidney transplantation.