*Purpose: The primary objective of this study was to evaluate the incidence of ureteral complications at a single transplant center. A secondary objective was to evaluate the effectiveness of non-surgical vs. surgical repair modality.

*Methods: We conducted a retrospective cohort study of consecutive (living and deceased donor) kidney transplants from 2012-2017 and identified patients with a post-op ureteral stricture or leak grouped by treatment modality. The difference in continuous variables across compared groups was assessed using independent sample t-test and for binary outcomes using chi-square test.

*Results: We analyzed 1,308 consecutive adult kidney transplants and identified 93 cases (7%) of ureteral strictures or leaks (56 strictures, 36 leaks, 1 both). Patients who developed a stricture or leak were transplanted with kidneys from significantly older donors (p<0.001), had a higher KDPI (p<0.001) and more instances of female donor to male recipient transplantation combinations (p=0.001). Length of stay (p<0.001) and delayed graft function (p=0.001) were statistically higher for those in the ureteral complication group.The two treatment modalities for strictures/leaks demonstrated no difference in location (distal vs. proximal), and overall graft/patient survival. Those with surgical repair had significantly higher occurrences of transplant admission renal complications (p=0.03) and bleeding complications (p=0.03).

*Conclusions: Our findings demonstrate significantly more ureteral complications of strictures and leaks post kidney transplantation with advanced donor age, higher KDPI and female donor to male recipient combination with statistical difference in complication outcomes based on repair type. These factors should be considered when managing kidney transplant recipients.

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