*Purpose: Tibetans is usually believed to have inferior clinical outcomes to Hans due to social economical and culture reasons. Limited data concerning kidney transplant (KT) in Tibetans is available. Here we reported the largest cohort of Tibetans kidney transplants and compare the clinical outcomes to Han patients.

*Methods: Patients greater than 18 years old, underwent first ABO compatible KT during 2006 and 2017 were included. A propensity score matching (PSM) of Tibetans to Hans was performed by 1:3. Survival, renal function and adverse events between the two groups were investigated.

*Results: Of 1820 patients, there were 123 Tibetans and 357 Hans were included after PSM. During the median follow-up of 48 months (range 6-96 months), there were no discrepancy in 1y-, 3y-, 5y- and 8y-death-censored graft survival (98.3%, 95.1%, 91.6%, 86.2% vs. 99.7%, 98.9%, 94.6%, 94.6% for Tibetans and Hans, respectively, p=0.061) and 1y-, 3y-, 5y- and 8y-patient survival (100%, 100%, 98.7% and 90.4% vs. 99.7%, 99.0%, 97.3% and 93.2%, respectively, p=0.721). The serum creatinine (SCr) was higher in Tibetans than Hans in 1 year (p<0.05) post-transplant, and estimated glomerular filtration rate (eGFR) was lower in Tibetans than Hans in 5 years (p<0.05) post-transplant, but no difference thereafter. There were no differences in other complications.

*Conclusions: KT of Tibetans achieved excellent and comparable long-term graft and patient survival to Hans, with similar long-term graft function. Further prospective studies are needed to confirm these results.

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