*Purpose: Graft survival is an important metric in which transplant centers are graded, yet center-level variation in kidney graft survival still exist after accounting for patient and donor characteristics. We aim to estimate the association of teaching status of a transplant with graft loss after kidney transplantation.

*Methods: We examined first-time single organ kidney transplant recipients from the Scientific Registry of Transplant Recipients from January 2008- January 2019, and linked data to the American Hospital Association Annual Survey by transplant center. Patients transplanted at teaching and non-teaching centers were compared using t-tests and chi-squared tests. Differences in death censored graft survival by teaching status and donor type were measured using the log-rank test. Using inverse probability weighting, we assessed the causal specific association between teaching status and the cumulative incidence of graft loss for both living and deceased donor transplants, after accounting for patient clustering by transplant center as well as donor, recipient and center-level characteristics.

*Results: Of 154,312 patients, 83% were transplanted at centers classified as teaching facilities. Teaching centers had a higher proportion of African American recipients (28.7% vs. 17.8%) but did not differ by other patient characteristics. Teaching centers demonstrated lower three-year graft survival than non-teaching centers among deceased donor transplant recipients (92.3%, 95% Confidence Interval (CI) (92.1-92.5) vs. 93.8%, 95% CI (93.4-94.2), p<0.0001) but did not differ among living donors (Figure 1).The three-year hazard of graft loss among deceased donor kidney transplants in non-teaching institutions was less than the corresponding hazard of graft loss at teaching institutions (Hazard Ratio (HR): 0.87, 95% CI: 0.78-0.98) after adjusting for patient clustering, donor, recipient and center-level characteristics. Among living donor kidney transplants, there was no association between teaching status and 3-year graft loss (HR: 1.07, 95% CI: 0.92-1.25) after adjustment.

*Conclusions: Transplant centers classified as teaching centers have a statistically significant higher incidence of graft loss for deceased donor recipients, although differences are relatively small. Processes of care between teaching and non-teaching centers should be further explored to identify causes of center-level variation in graft survival.

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