No series has specifically focused on rates of technical failure in the kidney transplantation operation. We retrospectively examined the incidence of technical graft loss in a single kidney transplant program. A total of 714 transplants were performed, with a mean follow-up of 3.4 years (range 2-5 years). Technical graft loss was defined as graft loss within the first 2 weeks, without evidence of allograft rejection. Fourteen patients (2%) demonstrated technical graft loss, none of whom received kidneys with multiple renal arteries (n = 106 with multiple renal arteries). The incidence of technical graft loss was significantly higher in diabetic recipients (4.3% vs. 1.4%, P = 0.03). The mean donor age was significantly higher (46.7 vs. 38.1 years, P = 0.05) in patients with technical graft loss. We observed that arterial thrombosis seemed to be related to the donor (older donor significant risk P = 0.04) and that venous thrombosis seemed to be related to the recipient (four of seven patients with positive hypercoagulable workup).