Background. The incidence of end-stage renal disease is rapidly growing among American Indians, but there have been no detailed reports of outcomes after renal transplantation in this population. Methods. We compared the effects of race on risks and outcomes for renal transplants performed at a single center. There were 68 transplants in American Indians, 55 in African- Americans, 32 in Asians, 33 in other races, and 1253 in Caucasians (total= 1441 transplants). Results. American Indian transplant recipients had a high prevalence of risk factors. American Indians were more likely to be diabetic (45.6%) compared with African-Americans (21.8%), Asians (9.4%), other races (15.2%), and Caucasians (25.9%); overall P<0.001. American Indian transplant recipients were more likely to be obese (25.0% had body mass index >30 kg/m2) compared with African-Americans (12.7%), Asians (3.1%), other races (6.1%), and Caucasians (9.7%); overall P<0.01. The percent of patients with peak panel-reactive antibody >50% was higher for American Indian recipients (32.4%) compared with African-Americans (16.4%), Asians (21.9%), other races (27.3%) and Caucasians (15.6%); P<0.01. Despite these differences in risk, there were no statistically significant differences in the incidence of acute rejection, patient survival, or graft survival between American Indians and other racial groups in univariate survival analysis. In a Cox proportional hazards model that adjusted for multiple risk factors, graft survival was not different for American Indians (P=0.71), African-Americans (P=0.60), or other races (P=0.34) compared with Caucasians, whereas Asians were only 44% as likely to have graft failure (P=0.07). Patient survival was not different among races. Conclusion. Outcomes for renal transplantation are excellent for American Indians, despite a high prevalence of risk factors.