Patient death continues to be a leading cause of renal transplant failure. This mortality is mainly due to cardiovascular, infectious and tumoural diseases. The aim of our study was to analyse the evolution of the mortality and its causes after renal transplantation (RT). We studied 3365 adult renal transplant recipients, surviving at least 1 year, and transplanted in Spain in the years 1990, 1994 and 1998. Risk factors for all-cause and specific-cause mortality were analysed employing simple and multivariate Cox regression. 300 patients (8.9%) died after the first post-transplantation year. The follow-up was shorter (maximum 2.5 years) in recipients transplanted in 1998. When we consider an identical follow-up (2.5 years) for all patients, we did not find statistical differences in mortality rates or its causes, in the three analysed periods. Cardiovascular diseases (CVDs) and neoplasia were the most frequent causes of death. Mortality was higher for males and patients > 60 years. Renal function, evaluated by creatinine level or proteinuria range at 3 months and its increase in the first year post-transplantation were significant factors associated with high risk for cardiovascular and infectious death. During the last decade, in Spain, the mortality after RT (2.5 years follow-up) remains stable. Recipient age (> 60 years), male gender and renal function in the first year were associated with higher risk of death, especially for CVD.