*Purpose: Early Foley catheter (Foley) removal after kidney transplantation (KTX) may reduce length of stay (LOS), however, a paucity of data exists as to the optimal Foley duration to avoid urinary complications. We hypothesize that Foley removal one day after KTX will reduce hospital LOS without adversely impacting outcomes.

*Methods: Consecutive adult kidney-only transplant recipients between 6/2014 to 5/2020 were retrospectively reviewed. Recipients whose Foley was removed on post-operative day one (D1) were compared to those whose Foley was removed later (>D1). Primary outcomes included urine leak, catheter reinsertion, hospital LOS, 30-day readmission, and 90-day bacteriuria.

*Results: There were 186 recipients in the D1 group and 327 in the >D1 group. D1 (vs. >D1) recipients were less likely to have a ureteral stent placed (11.8% vs. 28.1%, p<0.01) or be sensitized (23.7% vs. 35.5%, p<0.01). Ureteral leaks occurred in two patients in the D1 group (1.1%) and four in the >D1 group (1.2%, p=1.0). Those in the D1 group were more likely to have their Foley reinserted (11.8% vs. 5.8%, p=0.02) (Figure). Interestingly, this trend persisted in females (14.9% vs. 5.6%, p=0.04) but not males (9.8% vs. 5.9%, p=0.30). LOS>4 days was lower in the D1 group (47.3% vs 57.8%, p=0.03). There were no differences in 30-day hospital readmission (25.3% vs. 27.2%, p=0.70) and 90-day bacteriuria (48.4% vs. 49.5%, p=0.87).

*Conclusions: Foley removal one day after KTX may be useful in reducing LOS without adverse consequences. However, Foley reinsertion is more likely.

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