During the five-year period September 1974 through August 1979, two hundred nine consecutive patients received their first kidney transplant in Denver. During 2.5 to 7.5 years of follow-up, 54 patients (26%) died. Infection was the leading cause of death during all intervals and was responsible for 22 (41%) of the 54 deaths. Pneumonia was primarily responsible for 14 of the 22 deaths from infection. The other causes of death were cardiovascular problems in 11 patients (20%), suicide in eight patients (15%), gastrointestinal (GI) tract problems in seven patients (13%), malignant neoplasms in two patients (4%), and miscellaneous problems in four patients (7%). Twenty-six (48%) of the 54 deaths occurred more than one year after primary transplantation; 12 of these 26 patients had already returned to chronic hemodialysis. To minimize mortality after transplantation, patients and their physicians must remain alert to the ongoing risks to which these patients are exposed, including the risks of sudden death from infection, myocardial infarction, pulmonary embolus, suicide, or GI tract perforation.