*Purpose: Native Hawaiians and Pacific Islanders (NHPI) have an increased risk of chronic kidney disease with disproportionately fewer patients receiving kidney transplants; this study aims to determine the outcomes for renal transplants in this unique patient population.

*Methods: A retrospective review of a single-institution database with high NHPI population was performed for all deceased donor renal transplant (DDRT) recipients between July 2012 and September 2019. Donation after cardiac death graft recipients, multiorgan transplant recipients, and recipients with previous transplants were excluded. The recipient and donor characteristics and recipient outcomes were examined, and comparisons between the different gender and racial/ethnicity groups were performed. Kruskal-Wallis test with Dunn-Bonferroni post hoc method was used to compare continuous variables, and Pearson chi-squared test was used to compare categorical variables. Binary logistic regression was used for multivariate analysis. All statistical tests were performed using SPSS Statistics Subscription. A p-value of < 0.05 for statistical significance was used.

*Results: From July 2012 to September 2019, a total of 231 initial DDRT with donation after brain death grafts were performed in the institution. Twenty-five (10.8%) patients were NHPI. The rates of delayed graft function (DGF) among the different gender and racial/ethnicity groups were significantly different (p=0.013). Male NHPI had an increased observed DGF rate as compared to the expected institutional rate (26.7 vs. 7.3%). There were no statistically significant differences between male NHPI and other recipient groups in terms of age, body mass index, Estimated Post Transplant Survival score, cold ischemia time, pre-transplant dialysis days, and Kidney Donor Profile Index. Male recipients had significantly lower calculated panel reactive antibody and lower donor-to-recipient weight ratio than female recipients; however, there were no significant differences between NHPI and non-NHPI within the gender groups. There were no statistically significant differences for acute rejection and graft failure rates between the various gender and racial/ethnicity groups. On multivariate analysis, being a male NHPI remained the only statistically significant variable for DGF.

*Conclusions: Male NHPI DDRT recipients have significantly increased risk of DGF despite having no significant differences in the examined recipient characteristics and donor quality. Further studies are required to determine other biological or socioeconomic etiologies for this disparity in outcomes.

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