BACKGROUND: Since the initial report on anesthesia for the renal transplantation from Peter Bent Brighan Hospital in 1962, the anesthesia for kidney transplantation has been reviewed and discussed by many authors. We have performed 200 renal transplantations from August 1990 to October 1996. No cadaveric donor was used and all except two cases was the first graft. METHODS: Anesthetic procedures in the recipients were as follows; 1) The recipient was dialysed within 24 hrs prior to operation. 2) Premedication was done as glycopyrrolate and fentanyl, or glycopyrrolate and diazepam. 3) Thiopental and vecuronium, or thiopental and succinylcholine were used for anesthetic induction. 4) N2O-O2-relaxant (vecuronium) with halothane or isoflurane were used for maintenance. 5) Neostigmine or pyridostigmine were also used to antagonize against the relaxant. 6) CVP was maintained around 10~17 cmH2O. RESULTS: The results were as follows; 1) The mean ages of donors and recipients were 35.3 and 37.4, respectively. The ratio of male to female of donors and recipients was 1.6 : 1 and 1.6 : 1, respectively. 2) One hundred and ten cases (55.0%) were living unrelated donors and 90 cases (45.0%) were living related donors. 3) Overall graft and patient survival rate was 96.9 and 98.0 at 1 year, 94.1 and 95.1 at 3 years. CONCLUSIONS: Most patients with renal failure have several common problems that are of significance to anesthesiologists, including anemia, bleeding tendency, electrolyte imbalance, acidosis, hypertension, hyper- or hypovolemia, and previous therapy with steroids and immunosuppressants, etc. Therefore anesthesiologists should keep in mind the risk factors above mentioned for the anesthetic management of patients with renal failure.