Early surgical complications following living-donor kidney transplantation: a single-center retrospective study

Living-donor kidney transplantation is widely accepted as the optimal therapeutic option for patients with end-stage renal disease. Despite substantial progress in surgical methods and perioperative management, early surgical complications remain an important cause of morbidity, particularly in developing transplant programs. We retrospectively analyzed 35 consecutive living-donor kidney transplantations performed between January 2020 and December 2024 at a single center. Early surgical complications occurring within six weeks after transplantation were classified as vascular, urological, lymphatic, or wound-related. All donor nephrectomies were performed laparoscopically, and recipients were managed using standardized immunosuppressive and postoperative surveillance protocols. Early surgical complications occurred in 26.7% of recipients. Vascular complications (6.3%) included renal artery stenosis, arterial thrombosis, and graft renal vein thrombosis. Urological complications (7.5%) consisted of ureteral kinking, urine leakage, and vesicoureteral reflux. Lymphatic complications (8%) presented as lymphoceles and were successfully treated with percutaneous drainage. Superficial wound infections occurred in 3.1% of cases. Delayed graft function was observed in three recipients and was associated with prolonged cold ischemia related to complex reconstruction. Grafts affected by established graft renal vein thrombosis were not salvageable. Early surgical complications remain common following living-donor kidney transplantation. Prompt diagnosis, timely intervention, standardized postoperative care, and experienced multidisciplinary transplant teams are essential to optimize outcomes.