Earlier work has shown adverse air pollution effects on kidney disease outcomes, yet the specific impact of ozone (O₃) on kidney transplant (KT) recipients remains unclear. We investigated the long-term O₃ exposure effects on KT outcomes employing a multipollutant model. This multicenter, longitudinal cohort study included 4,799 adult KT recipients who underwent transplantation during 2002–2020 at three major hospitals in South Korea. O₃ and fine particulate matter (PM₂.₅) exposures were estimated using residential-ZIP-code-based high-resolution machine learning models. Associations between O₃ exposure and all-cause mortality or death-censored graft failure (DCGF) were evaluated via time-varying Cox proportional hazards models adjusted for poteintial confounders, including PM₂.₅. The mean annual O₃ and PM₂.₅ concentrations from one year posttransplant were 39.14±6.8 μg/m3 and 26.67±11.3 μg/m3, respectively. A 5-ppb increase in O₃ was associated with elevated risks of DCGF (hazard ratio [HR]=1.19; 95% confidence interval [CI]=1.04–1.37) and all-cause mortality (HR=1.39; 95% CI=1.15–1.69) after adjusting for PM₂.₅ and other confounders. These associations remained consistent across subgroup and sensitivity analyses. Chronic O₃ exposure significantly increases mortality and graft failure risk in KT recipients, highlighting the critical need for targeted strategies to mitigate air pollution’s impact on vulnerable transplant populations.