The review is about the most recent literature on complicated cases that manifest themselves following kidney transplantation, particularly during implantation surgery, due to vascular disorders and/or urinary tract abnormalities. The difficulty of kidney transplant implantation procedures was increasing as donors and recipients got older. Furthermore, the significant frequency of peripheral vascular disease across the world made the surgery more challenging and reduced long-term results. Furthermore, it raised transplant morbidity and mortality, both overall and cardiovascular, and lowered graft survival significantly. However, compared to transplanted patients, dialysis patients had an even worse mortality rate, with a proportionate risk of death 2.66 times greater. Aorto-iliac prosthesis, as well as 3rd and 4th transplants in occupied iliac fossae, were equally difficult procedures with a high risk of morbidity and death. In some of these cases, orthotopic kidney transplantation was a viable option with good functional and survival outcomes, but it was not without risks.

Compared to the non-risky group, vascular complex patients had inferior results after a kidney transplant. It is still a difficult surgical and medical process, with increased morbidity and mortality, as well as lower graft survival rates. However, the risk of death from dialysis is significantly higher, therefore a transplant may be necessary. In some individuals with aortoiliac unworkable segments or even those with unique urinary tract disorders, orthotopic kidney transplantation may be a viable option.