1. The number of kidney transplants performed at the University of Maryland increased yearly from 51 in 1991 to 285 in 1998. Over the past 3 years, the increase in the number of kidney transplants can be ascribed almost exclusively to a marked increase in living donor transplants, from 49 cases in 1995 to 130 cases in 1998; a 160% increase. The increase in our frequency of living-donor kidney transplantation can be attributed to a formal family education program and the availability of the laparoscopic technique for kidney removal. 2. In addition to the availability of the laparoscopic technique, a number of special programs has allowed an increased number of living donor kidney transplants. This includes a special protocol for transplantation of Epstein-Barr virus negative recipients, a protocol for transplantation of patients who have a positive crossmatch with a living donor, as well as, the simultaneous living donor kidney/cadaver pancreas "SPK(LRD/PTA)" program. 3. The one-year graft and patient survival for the entire program was 87.0% and 94.5%, respectively. However, the more recent graft survival rates have markedly increased; Since August 1995, the one-year graft and patient survival was 89.8% and 95.8%, respectively. 4. Improvement in immunosuppression has lead to dramatic improvement in the success rates in living-donor kidney transplants. Despite the omission of antibody-based induction therapy, the one-year graft survival rate using a mycophenolate mofetil/tacrolimus-based immunosuppression protocol was 96.4%. The one-year rejection rate was 8% in Caucasian patients and 14% in African-American patients in this subgroup of living-donor kidney transplant recipients. 5. The data demonstrate that the use of the living-donor transplant option is grossly underutilized. Estimates are presented that more than 11,000 living-donor kidney transplants should be possible in the US yearly.