Background: Despite some improvements in the conventional surgical technique for kidney transplantation, other (non-urologic and non-vascular) surgical complications may still occur with corresponding unfavorable effects on patient and graft survival.
Methods: Between March 17, 2014 and February 18, 2023, 50 pediatric and 657 adult recipients of a kidney-alone transplant were performed consecutively at our center, using a modified kidney transplant surgical technique.  All surgical complications were recorded; all patients were followed for a minimum of 12mo post-transplant.
Results: Overall, 8.8% (62/707) of patients developed a (non-urologic and non-vascular) surgical complication during the first 12mo post-transplant, which included 1.3% (9/707) for wound complication, 0.3% (2/707) for lymphocele, 2.3% (16/707) for peri-renal hematoma, and 5.9% (42/707) for peri-renal collection, respectively.  Two of the 9 patients who developed a wound complication (at 3.6mo and 4.4mo post-transplant) had an abdominal infection caused by mycobacterium abscessus at the removal site of the peritoneal dialysis catheter; both patients required multiple surgical abdominal wall debridement.  Additionally, 2/62 required a transplant nephrectomy as a direct consequence of their surgical complication: in 1 patient at 2 days post-transplant due to an unsuccessful attempt to treat a large peri-renal hematoma occurring along with lower pole rupture (possibly arising as a complication of the pretransplant donor biopsy), and in 1 patient at 3.3mo post-transplant due to the development of a Page kidney caused by a large peri-renal hematoma arising immediately following the performance of a clinically indicated kidney allograft biopsy at 2.7mo post-transplant.  None of the other 58 patients required surgical repair.
Conclusion: Surgical complications continue to be risk factor for morbidity after kidney transplantation; however, their incidence can be reduced significantly with the use of this modified surgical technique (see other abstract).