Introduction: To compare various outcomes of renal transplant according to the renal artery anastomosis technique, including end-to-end external iliac artery (EIA) or end-to-side internal artery anastomosis (IIA). Methods: The search for relevant literature was conducted comprehensively, without any constraints on publication date, including PubMed, Scopus, Embase, Medline, and Web of Science, as well as Google Scholar. The investigation focused on specific keywords, including "renal transplant," "vascular anastomosis," "graft outcome," " IIA anastomosis," and " EIA in renal transplant patients." All outcomes pertinent to these areas have been included in this review. Results: From an initial pool of ۵۵ articles identified in our search, we focused on specific outcomes related to graft function, renal artery stenosis, erectile dysfunction, and various postoperative and vascular complications. After thorough evaluation, we narrowed our selection to ۱۹ articles for in-depth analysis. Most studies showed no significant differences in intraoperative cold ischemia time between the two surgical methods, although one study noted a longer anastomosis time for internal iliac artery (IIA) procedures. In terms of graft function, five studies found no significant difference between the two techniques, while two studies suggested better outcomes with IIA anastomosis. Findings on renal artery stenosis (RAS) varied, with one study favoring external iliac artery (EIA) anastomosis and another supporting the IIA approach. Regarding erectile dysfunction (ED), four studies indicated higher rates following IIA anastomosis, one study found EIA to have a greater incidence, and another study detected no differences. For vascular complications, three studies reported no obvious differences between the two techniques, while one indicated that choosing the common iliac artery for anastomosis might reduce
complication rates, highlighting the significance of site selection in surgical outcomes.Conclusion: In kidney transplantation, the comparison of renal artery anastomosis techniques—end-to-side EIA and end-to-end IIA—showed no significant differences in graft function, vascular complications, or intraoperative cold ischemia time. However, the IIA anastomosis was related to a higher prevalence of erectile dysfunction among patients.