*Purpose: The standard of care in kidney transplantation has evolved with advances in immunosuppressive therapy. Few transplant surgeons experienced the realization of these advances firsthand. We summarize Dr. Mark Deierhoi’s experience as the most prolific US kidney transplant surgeon.

*Methods: Local transplant registry and UNOS data were utilized to identify adult, kidney-only transplants performed by Dr. Deierhoi (7/23/1986-12/25/2017). Analysis of variance was used to evaluate era differences in estimated posttransplant survival (EPTS), kidney donor profile index (KDPI), and living KDPI (LKDPI). Kaplan Meier methods and log-rank tests were used to determine era differences in 1- and 3-year graft failure rates.

*Results: Among 2,237 recipients (living donor kidney transplants (LDKT): 43%; deceased donor kidney transplants (DDKT): 57%), EPTS scores demonstrated recipients became sicker over time (LDKT p<.001; DDKT p<.001). LKDPI and KDPI reflected decreasing kidney quality over time (LKDPI p=0.01; KDPI p=0.04). Among LDKT recipients, 1-year graft failure improved from 8.6% to 2.8% (p=0.01), and 3-year graft failure improved from 18.3% to 7% (p<.001; Figure 1A). Among DDKT recipients, 1-year graft failure improved from 20.9% to 3.5% (p<.001), and 3-year graft failure improved from 31.5% to 8.1% (p<.001; Figure 1B).

*Conclusions: These data reveal significant improvements in graft failure over time, despite transplanting sicker recipients with lower quality kidneys. These data reflect the progress achieved in transplantation over the last 3 decades and honor Dr. Deierhoi’s contributions to the field.

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