*Purpose: Renal failure secondary to urological disorders can necessitate urinary diversion or reconstruction either pre or post-kidney transplant. Decision making regarding timing of diversion or reconstruction are affected by living (LD) or deceased (DD) donor options. We assessed our transplant outcomes into urinary diversions and reconstructed bladders.

*Methods: Single centre retrospective review of kidney transplants between 1986-2019. Graft and patient survival (GPS) were calculated, and compared to our general transplant population.

*Results: 87 patients (mean age 38.2) who had 97 transplants requiring urinary diversion or reconstruction. 80 of 97 were first transplants. Mean follow-up was 141 months.

Cutaneous ureterostomy (CU): 18 transplants (8 living donors, 10 deceased donors); 16 formed at time of transplant. 1 patient required two sequential transplants; first was diverted to cutaneous ureterostomy 3 years post-transplant (for unrecognised neuropathic bladder), the second a planned cutaneous ureterostomy. The other cutaneous ureterostomy was formed 4 years post-transplant for vesico-vaginal fistula from radiotherapy for cervical cancer.

Pre-formed ileal conduit: 15 transplants into pre-formed ileal conduit (7 living donors, 8 deceased donors). 7 of 15 died during follow-up, 4 of 7 with functioning transplant in-situ.

Post-transplant ileal conduit: 7 transplants (2 living donors, 5 deceased donors) into bladder but subsequent IC diversion (5 for bladder cancer, 1 for spina bifida and 1 for recurrent urosepsis).

Reconstructed urinary tract: 57 transplants into augmented bladders using native ureter (4), gastric-segment (1), ileo-caecum (7) and ileum (45). 13 were augmented post-transplant; 2 were undiverted into neobladders post-transplant.

*Conclusions: Transplantation into urinary diversions and reconstructed bladders appears safe, with similar graft and patient survival to our general transplant population. There has been a significant increase in planned living donor transplant for patients with complex urinary tracts. DD kidney recipients with unsafe bladders may require initial cutaneous ureterostomy before undiversion and reconstruction to prevent complications from a “dry” augment.

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