*Purpose: Previous studies indicated that the short-term (1 year) allograft survival of kidney transplants has improved significantly over the years. However, less is known about long-term survival. Our aim was to evaluate long-term outcomes of 1 year transplant survivors and evaluate the temporal trends of these outcomes.

*Methods: We retrospectively analyzed 385,687 recipients from 1991 to 2017 using the United Network for Organ Sharing (UNOS) data. Pediatric recipients (<18 years age) and multi-organ transplants were excluded. Time-to-event analysis was performed using multivariable Cox regression, and survival trends were plotted using The Kaplan-Meier method.

*Results: Adjusted long-term outcomes among kidney transplant recipients have improved steadily over time. Compared with patients transplanted in the reference period 1991-1995, transplant recipients in later decades had lower risk of mortality. The 5-year periods from 1996-2017 showed decreasing hazard ratios (p<.01) for both patient mortality (Tab. 1) and graft failure (Tab. 2 and Figure 1). The highest reported causes of death were cardiovascular event, sepsis and malignancy.

*Conclusions: In contrast to some earlier studies, this study indicates that long-term graft and patient survival of kidney transplants has steadily improved over the past 30 years. Although innovations in immunosuppression may have been one of the reasons for these improvements, further investigation into other factors is necessary to fully understand the observed variance.

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