*Purpose: To study the impact of the relative donor kidney size on long-term graft function and survival, we investigated the living donor renal transplants outcomes.

*Methods: We retrospectively assessed 1255 adult living donor kidney transplantation cases from January 2000 to December 2013 in Severance hospital. The chronological relationship between renal parameters and the kidney weight-to-recipient body weight (KW/BW) were analyzed.

*Results: Based upon KW/BW, the patients were divided into 4 groups, 1^st quartile (KW/BW < 2.9; n=313), 2^nd quartile (2.9≤KW/BW<3.5; n=314), 3^rd quartile (3.5≤KW/BW<4.2; n=315), 4^th quartile (4.2≤KWBW; n=313). The overall and death-censored graft survival at 10 years after transplantation were lower in 1^st quartile group than others (p<0.05). The 1^st quartile group showed lowest eGFR (p<0.05) at postoperative 1,6 months but the renal function of this group improved steadily, and after a year after surgery, the statistical difference was diminished compared to other groups. From 5 years after transplantation, the eGFR of 1^st quartile group declined significantly lower than other groups (p<0.05) and this phenomenon sustained up to 10 years after operation.

*Conclusions: The KW/BW ratio is the independent determinant for long-term renal graft function and graft survival.

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