Risk factors and temporal trends of early urological complications after kidney transplantation: a 15-year single-center cohort study

Background Urological complications remain a significant source of morbidity following kidney transplantation, often leading to re-intervention and graft dysfunction. Although advances in surgical technique and perioperative care have reduced incidence rates, controversy persists regarding risk predictors and the prophylactic role of double-J ureteral stenting.Methods We retrospectively analyzed 425 adult kidney transplant recipients at a single tertiary center between January 2008 and December 2023. Patient demographics, donor characteristics, surgical variables, and postoperative outcomes were reviewed. Complications were defined as urinary leak, ureteral stricture, or anastomotic obstruction requiring intervention within 12 months. Data were compared across three eras (2008–2012, 2013–2017, 2018–2023). Multivariable logistic regression identified independent risk factors.Results Overall, 11.1% (n = 47) of patients developed urological complications. Ureteral stricture was the most frequent (57%), followed by urinary leak (28%) and anastomotic obstruction (15%). Older recipient age (OR 1.04, 95% CI 1.01–1.07, p = 0.012), re-transplantation (OR 2.95, 95% CI 1.12–7.77, p = 0.028), and deceased donor grafts (OR 2.17, 95% CI 1.12–4.19, p = 0.021) were independent predictors. Prophylactic double-J ureteral stenting demonstrated a non-significant protective trend (OR 0.71, 95% CI 0.44–1.15, p = 0.091). Routine stenting in Era 3 coincided with a non-significant reduction in leak and stricture rates.Conclusion Older age, re-transplantation, and deceased donor grafts independently predicted complications, while prophylactic stenting showed a non-significant protective effect. Further multicenter studies are needed to validate these findings and optimize stent protocols.