To determine short- and long-term patient and graft survival in obese [body mass index (BMI) ≥ 30 kg/m2] and nonobese (BMI < 30 kg/m 2) renal transplant patients we retrospectively analyzed our national-database. Patients 18 years or older receiving a primary transplant after 1993 were included. A total of 1871 patients were included in the nonobese group and 196 in the obese group. In the obese group there were significantly more females (52% vs. 38.6%, P < 0.01) and patients were significantly older [52 years (43-59) vs. 48 years (37-58); P < 0.05]. Patient survival and graft survival were significantly decreased in obese renal transplant recipients (1 and 5 year patient survival were respectively 94% vs. 97% and 81% vs. 89%, P < 0.01; 1 and 5 year graft survival were respectively 86% vs. 92% and 71% vs. 80%, P < 0.01). Initial BMI was an independent predictor for patient death and graft failure. This large retrospective study shows that both graft and patient survival are significantly lower in obese renal transplant recipients.