*Purpose: Post-transplant immunosuppressive regimens may compromise wound healing, including at the surgical site. Transplant recipients are therefore especially susceptible to surgical site complications (SSC), such as infections and wound dehiscence. We aimed to assess the incidence, risk factors, outcomes, and economic impact of SSC in a large diverse population of kidney transplant recipients (KTR).

*Methods: We conducted a single-centre, cohort study of adult KTR who received a transplant from January 1, 2005 to December 31, 2015, excluding patients with simultaneous multi-organ transplants, and prior non-kidney transplants. The Kaplan-Meier product-limit method was used to determine the cumulative incidence of SSC and secondary outcomes. Risk factors and clinical outcomes were evaluated using Cox proportional hazards models. Linear models were used to study the effect of SSC on graft function.

*Results: The cumulative incidence of SSC at 30-days post-transplant was 4.1% (95%CI: 3.2, 5.3). Increased recipient body mass index (HR 1.07 [95%CI: 1.02, 1.12] per kg/m²), longer cold ischemic time (HR 1.05 [95% CI: 1.01, 1.09] per hour), and being transplanted from 2010 to 2012 (HR 2.32 [95%CI: 1.23, 4.36], vs. 2005-2009) were risk factors for SSC. Notably, patients with SSC were significantly more likely to experience death-censored graft failure (HR 3.08 [95%CI: 1.60, 5.90]) and total graft failure (HR 2.09 [95%CI: 1.32, 3.32]) but not death with graft function (HR 1.58 [95%CI: 0.82, 3.06]) or graft function at 12-months (-1.3 ml/min/1.72 m² [95%CI: -6.3, 3.7]). In addition, the median hospital costs incurred by patients with SSC was $2238.46 greater than that of patients with no SSC.

*Conclusions: Higher patient BMI, longer cold ischemic time, and transplants from 2010 to 2012 were factors associated with developing SSC. SSC was associated with as graft loss over follow-up. Further research on the clinical management of SSC may help to identify preventive and treatment approaches that may reduce the incidence and adverse outcomes of SSC in KTR.

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