*Purpose: We aimed to evaluate the relationship of 10-μm particulate matter (PM10) with the risk of graft failure, mortality, and decline of graft function in kidney transplant recipients (KTRs).

*Methods: Air pollutant data were obtained from the Korean National Institute of Environmental Research and linked to those of 1,532 KTRs who underwent kidney transplantation in Seoul National University Hospital and Seoul National University Boramae Hospital from 2001 to 2015. Survival models were used to evaluate the association of PM10 concentrations and the risk of death-censored graft failure (DCGF), all-cause mortality, and biopsy-proven rejection (BPR) over a median follow-up of 6.31 years.

*Results: Baseline exposure was defined as the 5-year average PM10 concentration, calculated retrospectively from the event day. The annual average PM10 exposure after KT was 27.1 ± 8.0 μg/m³. Based on the 5-year baseline exposure, a 1-μg/m³ increase in PM10 concentration was associated with increased risk of DCGF (hazard ratio [HR], 1.106; 95% confidence interval [CI], 1.068-1.146] and BPR (HR, 1.035; 95% CI, 1.009-1.061). All-cause mortality was significantly associated with 5-year average PM10 concentrations before the event (HR, 1.146; 95% CI, 1.090-1.205) in fully adjusted models.

*Conclusions: Long-term PM10 exposure have a significant association with respect to the risk of biopsy-proved rejections (BPR), death-censored graft failure (DCGF), and all-cause mortality.

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