Kidney transplantation is considered a cost-effective treatment compared to dialysis but accounts for a significant percentage of the public health care resources. Therefore, efficient systems capable of performing high number of procedures are attractive and sustainable.The aim of this study was to evaluate clinical outcomes of 11,436 kidney transplants regularly performed in a single transplant dedicated center over the last 18 years.This was a retrospective study performed in a single specialized transplant center. All consecutive patients who underwent transplantation between 08/18/1998 and 12/31/2015 were included in the analysis.The annual number of transplants increased from 394 in 1999 to 886 in 2015, with a progressive reduction in the proportion of living donor kidney transplants (70% vs. 23%) and yielding over 8869 patients in regular follow up. Of 11,707 kidney transplants performed, 5348 (45.7%) were from living, 3614 (30.9%) standard and 1618 (13.8%) expanded criteria deceased donors, 856 (7.3%) pediatric and 271 (2.3%) simultaneous kidney-pancreas transplants. Comparing 1998-2002 and 2011-2014, five-years graft survival increased for kidney transplants performed with living donors (83.3% vs. 93.1%, p < 0.001), standard deceased donors (60.7% vs. 79.7%, p < 0.001), expanded criteria donors (46.5% vs. 71.5%, p < 0.001) and for the pediatric population (79.8% vs. 80.9%, p = 0.684).The implementation of a dynamic and efficacious health care system was associated with a progressive increase in the number of kidney transplants, in the cumulative number of patients in follow up and a shift from living related to deceased donor kidney transplants, with associated progressive increase in patient and graft survivals.