*Purpose: Previous studies showed socioeconomic status affect the level of access to and prognosis of kidney transplantation. Further study is warranted to investigate the changes of socioeconomic status and their association with patient prognosis after kidney transplantation.

*Methods: This study was a nationwide observational cohort study in South Korea including kidney transplant recipients from 2007 to 2016. Ones’ employment status and economic grades were identified from the claims database through investigating health insurance enrollment status. The changes in the recipients’ socioeconomic state from a year before until 5 years from their transplant were first investigated through a generalized linear mixed model. Whether changes in socioeconomic status on 3 years after kidney transplantation were associated with patient prognosis was studied by assessing the risks of graft failure by Cox regression.

*Results: Among 15,215 kidney transplant recipients included, the median age at kidney transplantation was 48 years old, and 59.2 % of recipients had male sex. There were 31.9% cases of preemptive kidney transplantation, whilst, 18.1% kidney transplant cases had prior dialysis duration ≥ 5 years. Prevalence of pre-transplant diabetes mellitus and hypertension were 32.6% and 86.7%, respectively. Regarding the baseline socioeconomic status, the median economic grade was 56-60 percentile of the nation. In addition, 26.9% of the recipients were employed individuals at the time of transplantation. There was a significant change in the recipients’ socioeconomic status after kidney transplant, as there was a decrease in economic grades occurred within 2 years from kidney transplant and the employment rate also decreased in the period. After 2 years, there was a significant increase in employment rate while there was a nonsignificant change in economic status. Those who did not improve in their economic grades after 3 years from kidney transplant showed higher risks of deaths when compared to those who improved. Being unemployed after kidney transplantation was associated with a significantly higher risk of death-censored-graft-failure when compared to those who remained to be employed.

*Conclusions: Socioeconomic status changes dynamically after kidney transplantation and such changes are associated with patient prognosis.

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