The aim is to address the effect Rh (D) blood group on graft and patient survival in live donor kidney transplantation. Between 1983 and 2003, 1500 consecutive live donor renal transplants were performed in a single institution. Among these patients 1372 patients (group I) received Rh identical allograft (1025 males and 347 females, mean age 29.9, range 6 to 57) while 128 patients (group II) received Rh non-identical allograft (96 males and 32 females, mean age 30.9, range 7 to 58). Data were reviewed for clinical relevance of Rh nonidentity upon long-term graft function and survival. The two groups were homogenous regarding recipient age and sex, donor age and sex, HLA-A, B-and -DR mismatches, ABO blood group identity, number of blood transfusion and type of primary immunosuppression. The Rh non identity was more common among unrelated donors. The acute and chronic rejections were comparable in recipients with Rh identical and Rh non identical donors (p = 0.33 and 0.66 respectively). The mean serum creatinine at 1 year was 1.4 ± 0.6, 1.3 ± 0.4 (p = 0.1) while it was 1.8 ± 1, 1.7 ± 0.9 (p = 0.5) at 5 years for both groups respectively. The 1, 5 and 10 year graft survival were 94%, 78% and 54% in recipients with Rh identical donors while they were 95%, 82% and 57% in recipients with Rh non identical donors respectively. Rh (D) blood group system is not likely to be clinically relevant histocompatibility barrier to live donor renal transplantation.