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In this study, we aimed to clarify the factors that may effect long-term graft and patient survivals. We retrospectively evaluated the outcome of 112 renal transplant recipients who shared paired cadaveric kidneys between 1985 and July 2001. There were two study groups, each with 56 patients, according to the timing of the operations. The operations were performed by the same transplant team, so Group 1 represents the recipients of the first kidney and Group 2, the second. The same low-dose triple drug immunosuppression protocol with prednisolone, azathioprine and cyclosporine A was used in both groups. Cyclosporine A was converted to tacrolimus in seven patients in Group 1 and in five patients in Group 2. Demographic properties, number of acute-rejection episodes, serum creatinine levels, creatinine clearance values, graft and patient survival rates, postoperative complications, recipient body weights, cold ischemia times, and de novo malignancies were studied. To analyze our results the Chi-square and Wilcoxon Signed Ranks tests were used, differences, with P <0.05 were accepted as significant. Regarding the HLA matchings, the groups were similar. Mean cold ischemia times were 22.1±8.7 and 23.3±9.1 h in Groups 1 and 2, respectively (P >0.05). Acute-rejection rates within the first month following the transplantation were also similar in both groups. Serum creatinine levels and creatinine clearance values at 30 days post-transplantation showed no significant difference between the groups ( P >0.05). One, 2 and 5 years' graft survival rates (Group 1 vs. Group 2) were 97% vs. 92%, 74% vs. 77% and 27% vs. 24%, respectively. No statistically significant difference was observed on returning to the hemodialysis rates (10/56 vs. 13/56). In Group 2, the rate of proteinuria (over 200 mg/day) throughout the follow-up period was significantly higher than that in Group 1 (Chi-square, P =0.03). Three patients underwent re-transplantation: one in Group 1 and two in... [ABSTRACT FROM AUTHOR]