BACKGROUND: The aim of this study was to investigate the relationship between ultrasonographic elastography score and long-term renal prognosis in renal transplant patients. METHODS: A retrospective cohort study of 100 patients who underwent renal transplantation in our hospital between 2005 and 2022 was performed. Patients were divided into two groups as those with elastography scores higher than 8.45 kPa (n = 50) and those with elastography scores equal to or lower than 8.45 kPa (n = 50). Elastography measurements were performed with Siemens Acuson S2000 ultrasound system and the scores were compared with renal function parameters and other clinical characteristics. RESULTS: Patients with high elastography scores had smaller kidney size (P = .010), lower eGFR (P = .002), and higher proteinuria and albuminuria levels (P <
.05) than patients with low elastography scores. There was a significant association between elastography score and the risk of renal dysfunction (OR = 1.039, P = .006). CONCLUSIONS: A large elastography score may act as a significant biomarker for prognosing the risk of renal dysfunction in subjects undergoing kidney transplantation. These findings suggest that elastography may become an invaluable noninvasive tool during the long-term follow-up of patients with renal transplants.