Advances in knowledge in transplantation have improved renal allograft survival in all age groups of pediatric patients. However, the results from many studies have shown that the long-term allograft is least successful in adolescent recipients. The major cause of late graft failure can be contributed in large measure to medication non-compliance. We found a 53% admitted non-compli ance in adolescent compared to 17% in younger children. The rate of grafts loss among adolescents because of non-compliance is 15%, whereas 26% demonstrated graft dysfunction. Medication non-compliance in teenagers has been shown to be > 4 times greater than in adults. Teenager years are a time of transition from childhood to adulthood. Important tasks during this transition include the development of autonomous identity that progresses to full independence. However, the cognitive skills and intellectual maturation of adolescents are still limited. This is particularly true in teenagers with chronic disease. They have difficulty with abstract thinking, particularly the conceptualization of future consequences of present action. There are a number of strategies that are helpful in mitigating non-compliance. Adolescents must be dealt with directly. Previous non-compliant behaviors should be acknowledged. Efforts should be made to choose medications that have the least side effects. Psychological conditions such as post-traumatic stress disorder require early recognition, diagnosis and treatment. It is necessary to build rapport with teenagers and this should start before transplantation. A multi-disciplinary approach with physicians, social workers, nurses and transplant coordinators is an effective mean of enhancing compliance. A thoughtful approach to prescribe immunosuppressive regimens that minimize adverse side effects, an active involvement in medication related problems and understanding of adolescent developmental behavior is rewarded with better transplant outcome.