Background. Risk factors for surgical complications (SCs) following kidney transplantation in the modern transplant era need to be identified to perform appropriate prophylactic interventions.

Methods. Records from 870 consecutive adult cadaveric kidney transplants done at a single centre were reviewed. SCs were classified into four groups: (i) vascular (12%, thrombosis or stenosis); (ii) haemorrhagic (12%); (iii) ureteral (7.5%, leaks and stenosis) and (iv) wound (16%, lymphocoeles or dehiscences).

Results. One or more SCs occurred in 299 (34%) patients, with multiple SCs in 65 (7.4%). By logistic regression analysis, recipient vessel atherosclerosis and delayed graft function (DGF) were significantly associated with both thrombotic complications [odds ratio (OR) 4, 95% confidence interval (CI), 1.4–11, P = 0.010 and OR 3.8, 1.3–12, P < 0.00001, respectively] and graft artery stenosis (OR 2.9, 1.2–6.8, P = 0.015 and OR 5.6, 2.3–13.4, P < 0.0001, respectively). Acute rejection increased the risk of graft artery or ureteral stenosis by 2.5 (CI 1.02–6.4, P = 0.045) and 3.3 (CI 1.1–10, P = 0.034), respectively. Older recipients were related to urinary leak (OR 1.04, CI 1.01–1.07, P = 0.011). Difficult bench surgery, DGF and the use of antiplatelet drugs increased the risk of bleeding by 3.6 (CI 1.9–6.4, P < 0.0001), 2.7 (CI 1.5–4.7, P < 0.0001) and 1.8 (CI 1.03–3.29, P = 0.038), respectively. Each month on dialysis increased the risk by 1.02 (CI 1.01–1.03, P = 0.002). Sirolimus increased the risk for wound SCs by 4.1 (CI 2.1–8.3, P < 0.0001) and obesity, retransplant and acute rejection were additional risk factors.

Conclusions. Adult renal transplant recipients at risk for SCs can be identified by age, DGF, graft vessel and recipient atheromatosis, difficult bench surgery, obesity, rejection and the use of antiplatelet drugs and rapamycin.