Context: Chronic rejection is currently the most prevalent cause of renal transplant failure. Chronic rejection develops in grafts that undergo intermittent or persistent damage from cellular and humoral responses resulting from indirect recognition of alloantigens. Many risk factors of kidney graft failure were proposed, including whether they are linked to donors, transplantation, and recipients. Aims: The primary objective of this study was to identify potential risk factors resulting in early onset chronic graft rejection in recipient/living-related donors couples of renal transplants. Settings and Design: A retrospective observational study was conducted in a university hospital. Methods and Material: Sample size calculation: According to the G*Power 3 software, the calculated minimum sample of 86 participants (43 couples (recipient/donor) underwent renal transplant) was needed to detect an effect size of 0.82 in the percentage of early chronic allograft rejection among kidney recipients, with an error probability of 0.05 and 90% power on a two-tailed test. Data from the 43 couples (recipient/donor) who had undergone renal transplants between December 2010 and July 2017 were analyzed. Eligible participants were kidney transplantation recipients who had had chronic kidney graft rejection within the first five years after transplantation operation with their living donors. Recipients were excluded if they had acute kidney graft rejection following transplantation, chronic kidney graft rejection after five years from transplantation, or if they showed immunosuppressive drug toxicity. Statistical analysis used: Data were reported and analyzed using IBM-SPSS 21.0 (IBM-SPSS Inc., Chicago, IL, USA). Descriptive statistics (means, standard deviations, medians, ranges, and percentages) were calculated. For continuous data, independent t-test/Mann Whitney U test analysis was carried out to compare between groups. For qualitative data, the Chi-square test was used to compare the difference in distribution. The P-value was set at 0.05 to declare significance. Results: This study analyzed data from 24 men and 19 women. The mean age of the recipients was 44.26 ± 14.6, while it was 37.51 ± 8.3 for the donor group. According to Human Leucocytic Antigen (HLA) matching, 53.4% were 3/6, 27.9% were 2/6, 14% were 4/6 and 4.7% were 1/6. Of the donors, 93% were PRA negative, and 7% were positive. Ten recipients (23.3%) had positive CMV IgG. Four recipients (9.3%) had positive HCV antibodies, while 39 (90.7%) had negative biomarkers. Conclusions:Possible risk factors in this group may include unrelated couples, HLA biomarkers mismatch, blood group A, co-morbidities such as diabetes mellitus or hypertension, obese donor, anemia or low hemoglobin level, Proteinuria, hypoalbuminemia, dyslipidemia, or previous viral infection.