*Purpose: Elevated levels of fine particulate matter, 10 μm in aerodynamic diameter (PM10) are associated with increased risk of cardiovascular outcomes and death, but their association with risk of graft failure and mortality in kidney transplant recipients (KTRs) has not been studied.

*Methods: Air pollutant data was obtained from the Korean National Institute of Environmental Research and it was linked to the 727 KTRs who received kidney transplantation in Seoul National University Hospital from 2001 through 2015. We used survival models to evaluate the association of PM10 concentrations and risk of graft failure and all-cause mortality for up to 5 years in KTRs. The 1-year average concentration of PM10 after kidney transplantation (KT) was used for analysis, and major air pollutants such as the concentrations of sulfur dioxide (SO₂), ozone (O₃), and carbon monoxide (CO) were adjusted as confounders.

*Results: During the study periods, annual average PM10 exposure after KT varied ranging from 28.3 to 73.27 μg/m³ (mean, 52.5 μg/m³). When patients were divided into two groups according to the mean annual concentration of PM10, patients with higher exposure to PM10 had increased risk of graft failure (Hazard ratio [HR], 3.08; 95% confidence interval [95% CI], 1.32 to 7.18) and also all-cause mortality (HR, 2.84; 95% CI, 1.02 to 7.89) in a fully adjusted models.

*Conclusions: Our findings demonstrates a significant association between the long-term exposure to PM10 and the risk of graft failure and morality in KTRs.

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