Reports of the progression of chronic renal failure to end-stage renal disease (ESRD) in recipients of nonrenal transplants have been contradicted by some reports suggesting a self-limited decrease in renal function without a measurable effect on patient outcomes. We performed a population-based cohort analysis involving recipients of heart, lung, liver, and intestine transplants who were included in the Scientific Registry of Transplant Recipients (SRTR) in order to determine the incidence of chronic renal failure, the risk factors for this condition, and the risk of death associated with it and to describe the outcomes of approaches to renal replacement (dialysis or kidney transplantation).