Purpose In 2025, approximately 1,750 patients in Western Australia require dialysis for end-stage kidney disease, with annual costs of $85,000 per patient. Kidney transplantation is a cost-effective, definitive treatment, but access disparities persist—especially for rural and remote patients. Many must relocate to metropolitan centres for dialysis, a burden that is under-reported and linked to significant psychosocial impacts, including social isolation, disrupted family and community ties and financial strain. This study examined clinical characteristics and outcomes of kidney transplant recipients across geographic remoteness levels to better understand these disparities. Methods We retrospectively analysed 266 kidney transplant recipients classified by the Modified Monash Model (MMM) of remoteness: Metropolitan (n=207), Regional Centres/Rural Towns (n=27), and Remote/Very Remote Communities (n=32) from 2019 - 2023. Data on demographics, dialysis duration, donor type, and one-year post-transplant outcomes (graft survival, function, hospital stay, complications) were collected. Results Remote recipients were mostly Aboriginal (63% vs 2.4% metropolitan) and socioeconomically disadvantaged. They had longer dialysis exposure (2.5 vs 2.0 years) and lower rates of living-donor (13% vs 27%) and pre-emptive transplants (3.1% vs 14%). Despite this, one-year graft survival and mortality were similar across groups. Remote patients showed the highest graft function (eGFR) but had longer hospital stays and more post-operative complications. Conclusions Rural recipients demonstrate resilience and achieve equitable outcomes despite barriers. However, persistent disparities and psychosocial costs of relocation require targeted interventions. Raising rates of pre-emptive and living-donor transplantation in rural and remote communities is crucial to addressing these inequities and improving patient outcomes.