This chapter concentrates on issues that arise from 6 months after transplant onwards and considers issues in the early post transplant period only insofar as they affect long-term management and outcome. With the advent of more powerful immunosuppressive medications and the expansion of the donor pool to include older donors with cardiovascular comorbidity, the impact of human leukocyte antigen (HLA) matching on outcomes in deceased donor transplantation has diminished considerably. Chronic graft dysfunction is the progressive loss of glomerular filtration rate (GFR) beginning months or years after transplantation. Many centers now advocate screening, by urine cytology or BKV polymerase chain reaction (PCR), for the first 2 years after transplantation. Strategies to reduce cardiovascular risk focus on minimizing time on dialysis, prevention and aggressive treatment of traditional cardiovascular risk factors and preservation of graft function. Women with renal transplants should be offered and encouraged to accept regular breast and cervical screening.