In view of the relatively low mortality risk on dialysis and the high risk of allograft loss among black compared with white end-stage renal disease (ESRD) patients, we studied the relative mortality risks of all black renal transplant candidates in Michigan from 1984 to 1989. There were 770 black ESRD patients followed from wait-listing for cadaveric (CAD) kidney transplantation until the time of transplantation, death, or December 31, 1989. The time on dialysis prior to wait-listing exceeded 1 year in 24% of these patients. Black diabetic patients on the waiting list have more than twofold relative mortality risk (RR) compared with nondiabetic individuals (RR = 2.73, P < 0.001) while the RR by diabetes status among CAD transplant recipients was small. Overall, CAD transplantation was associated with elevated risk of mortality in the first month posttransplantation (RR = 3.39, P < 0.03). Cadaveric donor transplant and wait-listed dialysis patients have equal death rates 112 days after transplantation. Thereafter, death rates were lower for transplant recipients compared with transplant candidates on dialysis. One year after transplantation, CAD transplant recipients on the average have approximately half the risk of death compared with dialysis patients who remain on the waiting list (RR = 0.49, P < 0.03). The cumulative survival probabilities are superior in transplant recipients just beyond 1 year after transplantation. Therefore, CAD transplantation in black ESRD patients is associated with a high risk of mortality in the early period after transplantation. Beyond 1 year, black transplant recipients have a substantial survival advantage over corresponding dialysis patients on the waiting list.