Introduction: Low socio-economic status (SES) has been associated with poorer access and worse outcome in kid-ney transplantation (KT) for high-income countries. In contrast, relatively little is known about the KT access and outcome between the socio-economic gradient in Malaysia, which is a low- and middle-income country. The aim is to determine the association of SES with access and outcome of kidney transplantation in Malaysia. Methods: We examined the Malaysian National Renal Registry for kidney transplant candidates listed between 2002 to 2011. Cox’s regression was used to assess associations of SES with transplant access and outcome (survival). Results: 1234 patients were transplanted in 2002-2011 after excluding pediatric patients and multiple transplantations. The mean age of patients was 42.3 ± 12.3 years, 789 (63.9%) were male and 797 (65.0%) were of Chinese ethnicity. After multivariate adjustment, the highest income group were 20% less likely to access KT compared the lowest income group (adjusted HR=0.80, CI: [0.62, 1.04] producing trend for P-Value = 0.001. While patient with highest education were 50% more likely to survive compared to patient with lowest education (adjusted HR=0.50, CI: [0.34, 0.73] producing trend for P-Value < 0.001. Conclusion: Even in a healthcare system that is almost achieving universal health coverage, disparities exist in both extremes of the socio-economic gradient for the access and outcomes for KT in Malaysia. Reducing the SES disparities in KT will require policy initiatives addressing the components of SES (income, education, and employment) as well as the pathways by which this affect the health of KT patient.