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INTRODUCTION AND OBJECTIVES: As the obese population has grown, minimally invasive renal transplant techniques have attempted to improve outcomes and the issues of complications related to wounds and hernias. The Anterior Rectus Sheath approach, which facilitates a minimal incision, has been adopted at our center for all renal transplants, including obese patients. Retrospectively, we analyzed the wound issues for obese patients as well as outcomes/graft survival, hypothesizing improvement over the standard approach. METHODS: Between January 1, 2011 to December 31, 2014, 166 renal transplants were performed at the Charleston Area Medical Center (CAMC) with the new approach adopted in November 2012. Of the extraperitoneal transplants, 71 adult patients were classified as morbid/severe ( 35) or obese (30-34.9) by body mass index (BMI). Demographics, perioperative results, and outcomes were retrospectively collected for the conventional (CON) and anterior rectus sheath (ARS) approaches until August 21, 2015. Intraperitoneal transplants, pediatric patients (due to classification of BMI), and those requiring simultaneous native nephrectomy were excluded. RESULTS: The ARS and CON groups were comprised of 40 (56%) and 31 (44%) patients, respectively. The majority of demographics and perioperative data indicated no significant statistical differences between populations (p