Objectives: The shortage of donor organs and the increase of waiting lists increase the waiting time for deceased donor kidney transplants (DDKT). We evaluated DDKT prognosis according to the pretransplant dialysis vintage Methods: A total of 4,117 first-time kidney transplant recipients were enrolled from a prospective nationwide cohort. DDKT recipients were divided into tertiles according to pretransplant dialysis duration. Graft failure, mortality, and composite were compared between DDKT and living donor kidney transplant (LDKT) recipients Results: Pretransplant dialysis vintage was longer annually in DDKT recipients. In the subdistribution of the hazard model for the competing risk (set as patient death), the first tertile did not show an increased risk of graft failure compared with LDKT recipients; however, the second and third tertile groups had an increased risk of graft failure compared to LDKT recipients (adjusted hazard ratio [aHR], 3.59; 95% confidence interval [CI], 1.69–7.63; P < 0.001; aHR, 2.37; 95% CI, 1.06–5.33; P = 0.037). All DDKT groups showed a significantly higher risk of patient death than LDKT, with the highest risk in the third tertile group (aHR, 11.12; 95% CI, 4.94–25.00; P < 0.001). The risk of the composite of mortality and graft loss significantly increased in tertile order compared with LDKT recipients (all P < 0.05) Conclusions: A longer pretransplant dialysis period was associated with a higher risk of the composite of patient death and graft failure in DDKT recipients. DDKT after a short period of dialysis had non-inferior results on graft survival compared with LDKT