Chronic kidney disease is iceberg in the world, particularly in developing countries. Progressive

chronic kidney disease leads to end-stage renal disease. The end-stage renal disease occurs when

the kidneys are no longer able to function at a level that is necessary for day-to-day life. Either

dialysis or kidney transplant is the mode of treatment. There is an acute need to increase kidney

transplant to offer a better life to end-stage renal disease patients. Access to dialysis and kidney

transplant in the developing world is limited because of a shortage of organ, affordability and

very expensive treatment for a lifetime. Hence, optimizing renal allograft survival is essential.

Health care between urban and rural populations is different due to disparities in wealth and

literacy. The most common causes of kidney disease in India in both men and women are

diabetes and hypertension. This study aimed to evaluate clinical outcomes and identify poor

prognostic factors in the renal transplant at the institute of kidney diseases and research center

(IKDRC), Ahmedabad. Antibody-mediated and viral infections lead to rejection. The rationale

of the present study was to understand the different mechanisms involved in the molecular

pathways of rejections. The study was designed with two main objectives in mind to understand

the causes of rejections in spite of best HLA matching. Also, there is a need to address problems

involved in kidney transplants like morbidity, rejections, infections and long term survival of the

graft