Kidney transplantation is universally accepted as the therapy of choice for children with end stage renal disease. Thus we assessed 216 children received transplants between 1985 and 2004. Mean age was 11.69 yr. 36.6% of our patients were girls and 63.4% were boys. Lower urinary tract anomalies accounted for 38.4% and reflux nephropathy for 32% of our patients. Graft failure was seen in 33.3% of patients. In patients who transplanted before 1997, chronic rejection was seen in 55.8% of patients and acute rejection in 75.2% of patients. In this group the most common cause of graft failure was chronic rejection. In patients who transplanted after 1997 chronic rejection was seen in 23% and acute rejection in 42% of patients. The cause of graft failure was chronic rejection and acute rejection in these patients (1997–2004). Patients mean graft survival time was 7.2 years. The rate of graft survival in the first year after transplantation was 88%; rates for the third, fifth, seventh and tenth years after transplantation were 74.6%, 69.2%, 48.9% and 42% respectively. We found significant relationship between age, date of transplantation, acute rejection, hyper-acute rejection and treatment program with graft survival. Children younger than 6 years old had lower graft survival (Pv =0.00). The results of transplantation improved in patients who transplanted between 1997 and 2004. The rate of graft survival in the first year after transplantation was 92%; rates for the fifth and seventh years after transplantation were 82% and 75% in these patients respectively. Whereas graft survival was 83% at 1 year, 37% at 5 years and 17% at 7 years in patients who transplanted between 1985 and 2000. The relationship between acute rejection and hyper-acute rejection and graft survival was significant (Pv =0.02). The relationship between the frequency (Pv =0.02) and interval of acute rejection after transplantation and survival was significant (Pv =0.00). Mean graft survival time was 8.8 years in patients without acute rejection, 4.8 years in patients who had acute rejection episodes in the first year after transplantation. For those whose first acute rejection episode occurred after the first year of transplantation, survival time was an average of 7.5 years. In this study, we found no relationship between chronic rejection and graft survival totally (Pv =0.13). This relationship was meaningful in patients who transplanted before 1997. Graft survival improved in patients with chronic rejection who received transplants after 1997. Because mycophenolate mofetil was used more in these patients, and we found significant relationship between this drug and graft survival (Pv = 0.00).