The aim is to evaluate the incidence and management of vascular complications following live-donor renal transplantation. The possible risk factors and their effects upon patient and graft survival were also assessed. A total of 1200 consecutive live-donor renal transplants were carried out for 1152 patients in a single institution. The incidence of different types of vascular complications were determined and correlated with relevant risk factors. The impact upon patient and graft survival was also studied. There were 34 vascular complications (2.8%). Stenotic or thrombotic complications were recorded in 11 (0.9%) including renal artery stenosis in 5 (0.4%), renal artery thrombosis in 5 (0.4%) and renal vein thrombosis in 1 patient (0.1%). Hemorrhagic complications were observed in 23 patients (1.9%). Although no risk factors could be identified in the development of stenotic or thrombotic complications, grafts with multiple renal arteries were significantly associated with hemorrhagic complications (P=0.04). Stenotic and thrombotic complication group as well as the hemorrhagic group was significantly associated with subsequent development of biopsy proven acute tubular necrosis (P<0.001). The 5-year patient and graft survival for those with vascular complications were 71.9±1.9% and 41.6±8.9% compared with 86.3±1.1% and 76.8±1.4% for the rest of our transplant population, respectively (P<0.001). The deleterious impact upon survival was not only observed in the group of recipients with thrombotic or stenotic crises but also in those with hemorrhagic sequelae. The hemorrhagic crises are as serious as the stenotic and thrombotic complications affecting both patient and graft survival. Being a significant factor in the development of hemorrhagic complications, grafts with multiple renal arteries should be managed critically.