The aim is to study the characteristics and the predictors of survival in Bahraini renal transplant recipients with an allograft that functioned for more than 10 years. Sixty three patients underwent renal transplantation between 1979 and 1997. Of these, 37 had functioning allografts for more than 10 yr (range, 10–28). Characteristics of the patients, data on graft survival, and determinants of outcome were obtained by reviewing all medical records. The mean age at the time of transplantation was 30.7±14 years. The donor source was 25 related and the mean age was 30.4±7 years. Thirty three patients received their first graft. Thirty three were cyclosporine (CsA) treated while 4 patients were primarily immunosuppressed by steroids and azathioprine and 21 patients received induction therapy. Acute rejection episodes occurred in 7 patients (58%), out of them 2 experienced two acute rejection episodes. At most recent follow-up (March 2008), the mean serum creatinine was 137±34 mmol/l. A history of cancer was noted in one patient whereas; hypertension was (54%) and diabetes mellitus in 20.5%. We compared the surviving group with the non surviving group at the same time of transplantation and found that the independent determinants of long-term graft survival were incidence of acute rejection episodes and histopathological findings of CAN. We concluded that renal transplantation even in its earliest years and despite the numerous complications have provided 10 or more years of near normal life to patients with end stage renal disease. Patients on CsA-based immunosuppression clearly didn't show any significant benefit on long-term graft survival than patients on azathioprine and steroids.