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Introduction:  Vascular complications are severe complications of pediatric kidney transplantation (KT). We aimed to investigate whether a complex bench surgery (BS) affects the outcomes., Methods:  All pediatric KT performed at the University Hospital of Padua from 2015 to 2019 were analyzed, comparing those in which a standard BS was possible to those that necessitated a complex BS. The rates of vascular complications, patients' outcome, and graft survival were compared in the two groups., Results:  Eighty KTs were performed in 78 patients with a median age of 11 years (interquartile range [IQR] 4.3-14) and a median body weight of 24 kg (IQR 13-37). Thirty-nine donor kidneys (49%) needed a complex BS due to anomalies of renal veins in 12 (31%) and renal arteries in 16 (41%). The remaining 11 grafts (28%) underwent an elongation of the vein. There was no difference in the rate of primary graft non function ( p  = 0.97), delayed graft function ( p  = 0.72), and overall survival ( p  = 0.27). The rates of vascular complications, bleedings, and venous graft thrombosis were similar ( p  = 0.51, p  = 0.59, p  = 0.78, respectively). No arterial thrombosis or stenosis was reported., Conclusion:  Complex BS did not compromise survival of the graft and did not put the allograft at risk of vascular complications, such as bleedings or thrombosis., Competing Interests: None declared., (Thieme. All rights reserved.)