*Purpose: Medical and surgical complications associated with obesity after kidney transplantation in the current era are unknown.

*Methods: We analyzed the records of consecutive first-time, kidney only recipients transplanted at our institution between 2010-2015.

*Results: We identified 1467 kidney transplant recipients during this period with a mean follow up of 5.1 ± 2.2 years. Less than 30% of the patients had BMI in normal range (BMI: 18.5 – 24.9). Obesity (BMI > 30) was associated with increased 30-day post-transplant readmission (p < 0.0001), 30-day post-transplant re-exploration (p=0.02), delayed graft function (p=0.008), length of stay after transplant (p=0.03), higher serum creatinine at 12 months post-transplant (p=0.04), cardiovascular events (p<0.0001) and congestive heart failure (p<0.0001). Multivariate analysis showed morbid obesity BMI > 40 (HR=5.84, 95%Cl 1.40 to 24.36, p=0.015), Age > 50 at time of transplant (HR=0.45, 95%Cl 0.2889 to 0.7031, p=0.0004), post-transplant length of hospital stay >4 days (HR=1.94, 95%Cl 1.1918 to 3.1807, p=0.008), 30-day readmission post-transplant (HR=2.25, 95%Cl 1.2032 to 4.2299, p=0.01), serum creatinine >1.5 mg/dl 12-months post-transplant (HR=1.95, 95%Cl 1.2024 to 3.1825, p=0.007) and urine protein-creatinine ratio > 1gm/gm (HR=1.85, 95%Cl 1.0616 to 3.2428, p=0.03) were associated with death censored graft failure. We did not find a direct association of obesity/overweight and graft failure. However, the variables associated with increased risk of death censored graft loss were all associated with obesity/overweight.

*Conclusions: In the current era of renal transplant care, obesity is common but not associated with increased risk of graft loss. However, high BMI remains associated with significant medical and surgical complications post-transplant.

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