Epidemiological data from the past decade suggest that the global burden of patients with renal failure who receive renal replacement therapy exceeds 1.4 million and that this figure is growing by about 8% a year.1 2 The UK renal registry from 2009 estimated that over 47 000 people received renal replacement therapy in the UK.3 Renal transplantation increases survival and improves the quality of life for patients with end stage renal failure.4 5 A recent UK estimate found that transplantation conferred a cost saving of £25 000 (€29 000; $40 000) a year per patient with end stage renal failure.6 In the UK rates of renal transplantation are increasing (fig 1⇓), and since 2006 the number of patients waiting more than five years for a transplant has halved, but there are still a large number (about 7000) of patients on the transplant waiting list (fig 1⇓).7 8

We review the process of selecting patients eligible for renal transplantation and the care of patients after renal transplantation for the primary care physician. This article is based on evidence from large registries, case series, clinical …