Abstract— The purpose of this paper is to compare the outcomes of midline and Rutherford-Morrison incisions in renal transplantation, focusing on wound complications, peri-graft haematoma, and biopsy-related complications within 90 days post-transplant. Background: Renal transplantation is the gold-standard treatment for end-stage kidney disease, yet little evidence exists on the impact of incision type, such as a lateral, Rutherford-Morrison incision compared to a lower midline incision on surgical outcomes, including wound complications. Incision type may also affect the position of the graft and may affect the ability to biopsy the graft and subsequent complications. The impact of incision type on wound complications and biopsy related complications remain unclear. Methods: A retrospective single-centre study was conducted of 413 renal transplant recipients at Royal Prince Alfred Hospital between January 2020 and January 2026. Patient demographics, donor characteristics, incision type, and post-transplant complications were recorded. Post operative surgical outcomes within 90 days, including wound complications, peri-graft haematoma and kidney transplant biopsy related complications were assessed. Results: Of 433 patients, 324 (74.83%) received a Rutherford-Morrison incision and 109 (25.17%) a midline incision. Biopsy-related complications occurred in 5.8% of Rutherford-Morrison and 8.1% of midline patients (p=0.652). Wound complications occurred 25.3% of Rutherford-Morrison and 18.3% of midline patients. Post-operative bleeding occurred in 9.9% of Rutherford-Morrison and 7.0% of midline patients. Mortality occurred in 0.6% of the Rutherford-Morrison and 2.8% of the midline patients. Conclusions: Midline incision is a safe and effective alternative to the Rutherford-Morrison incision in renal transplantation. It is associated with a lower incidence of wound complications and bleeding without increasing the risk of biopsy-related complications. Larger, multi-centre studies are warranted to confirm these findings and further guide surgical decision-making.