*Purpose: The aim of this study was to evaluate the effect of recipient obesity on posttransplant complications and patient and graft survival.

*Methods: A single-institution, retrospective study was performed on obese renal transplant recipients (BMI &gt 30 kg/m², n=102) from January 2010 to December 2018, matched with non-obese recipients (BMI &lt 30 kg/m², n=204). For comparison, for every obese patient we selected two non-obese patients with a similar age, gender, and period of transplantation. The comparative analysis included patient and graft survival as primary outcomes and graft function and postoperative complications as a secondary outcome.

*Results: Recipient demographics were comparable in both groups except for diabetic nephropathy in obese patients (p=0,0006). Obesity was strongly related to a poorer patient survival (RR=2,83 CI 95% 1,14-7,04; p=0,020) but no difference in graft survival was observed (p=0.6). While early graft function was inferior in the obese population (RR=2,41; CI 95% 1,53-3,79; p=0,00016), during late follow-up, no statistically significant differences were observed between both groups (p=0,36). Obese recipients had a significantly higher risk of DGF (RR=1,93; CI 95% (1,19-3,1), p=0,0077), heart infarction (RR=7 CI 95% 1,68-29,26; p=0,0042), wound infections (RR=8; CI 95% 1,96-32,87; p=0,0015), diabetes aggravation (RR=3,13; CI 95% 1,29-7,6; p=0,011), and surgical revision for eventration (RR=8; CI 95% 1,22-52,82; p=0,026) when compared with non-obese recipients.

*Conclusions: Despite the inferior early kidney graft function in obese recipients, no difference was observed at the long-term follow-up. However, recipient obesity demonstrated a negative impact on patient survival and post-operative complications.

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