Aboriginal populations experience a very high rate of end-stage renal disease (ESRD); however, little is known about the outcomes of transplantation in this population. We performed a retrospective database review to determine the short- and long-term outcomes of kidney transplantation in Aboriginals. Adult Aboriginal (AB) and Caucasian (C) individuals receiving primary kidney transplants between 1969 and 2003 in Manitoba, Canada were examined. A total of 705 recipients were included (126 AB and 579 C). AB recipients were younger, had different etiologies of ESRD, longer cold-ischemic times for deceased donor transplants, and higher peak panel reactive antibody levels. At 1 year post-transplant, there was no difference in serum creatinine, acute rejection or graft survival between AB and C recipients. However, AB recipients experienced greater weight gains early post-transplant and were more likely to develop post-transplant diabetes mellitus. AB recipients exhibited inferior 10-year graft (AB 26% vs. C 47%, p