Allogeneic grafts can be immunologically attacked by different rejection types: hyperacute, accelerated, acute, and chronic rejection. The introduction of the "crossmatch" before transplantation into the clinical routine completely prevents the hyperacute rejection. The development of new immunosuppressive agents, which are just approved, will make the management of accelerated rejection more efficient, too. Modern immunosuppressive agents are very efficient in the prevention of early acute rejection. In order to delay or even to prevent development of chronic rejection, the diagnostic of early and late acute rejection has to be improved. The clinically symptomless CMV infection is a very important risk factor of chronic rejection and an antiviral therapy can prevent acceleration of chronic rejection by CMV. We had to learn that CMV and other viral infection are not only a problem of the early post-transplant course. Another approach for prevention of chronic rejection is the reduction and control of unspecific inflammatory processes triggered peri-operatively by ischemia/reperfusion injury.