There are many obstacles in kidney transplantation. For the transplant team, there is the balance between immunosuppression to aid in the recipient’s tolerance of the allograft and the infection risk of a suppressed immune system. These potential long term complications of kidney transplantation are relatively well known, but there are many other complications that patients and families do not consider when preparing themselves for a kidney transplant. Although the benefits of attempting a kidney transplant far outweigh downfalls of the long term sequelae, kidney transplantation is by no means a benign procedure. It is the hope of these authors that the reader will leave with a sense of understanding towards the kidney recipients.