Aboriginal Australians have markedly higher rates of kidney disease. Rates of kidney transplantation from deceased donor kidneys are substantially lower, with few live donors. Outcomes from transplantation in this group appear to be poorer but have not been well examined.

Utilising the ANZDATA Registry, Australian primary deceased-donor kidney-only transplants 1991-2011 were examined (n=6451). Time to graft failure (composite of death with graft function & loss of graft function) was examined piecewise due to non-proportional risks. Subhazards for death with function vs. loss of graft function were examined with competing risks methods.

Aboriginal recipients (n=327) were younger and more commonly female, smokers, diabetic, and to have vascular disease or chronic lung disease; at transplant they had higher waiting times, peak PRA and HLA mismatches

Risk of graft failure (covariate adjusted) varied over time after transplantation, peaking 2 years after transplantation, with no interaction with year of transplantation.

Adjusted subhazard ratios showed increased risk for death with graft function from 3 months post transplantation, whereas the rate of graft loss was not increased until 12 months post transplantation.

Among Aboriginal recipients, the excess death rate was predominantly due to infectious causes in the first year (65% vs 37%), and thereafter cardiovascular causes (57% vs 31% in 2^nd year).

Although the outcomes among Aboriginal transplant recipients are poorer than non-Aboriginal recipients, the risk is not homogenous over time. Outcomes in the first 3 months are comparable; after this poorer graft outcomes reflect excess infective deaths in first year among Aboriginal recipients, with cardiovascular disease and increased loss of graft function later factors.

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