Despite a continuously growing knowledge of the impact of factors on kidney graft function, such as donor age, body mass index and cold ischemia time, few data are available regarding anastomosis time (AT) and its impact on long-term results. We investigated whether surgical AT correlates with patient and graft survival after kidney transplantation performing a retrospective analysis of 1245 consecutive deceased donor kidney transplantations between 01/2000 and 12/2010 at Innsbruck Medical University. Kaplan-Meier and log-rank analyses were carried out for one and five year patient and graft survival. Anastomosis time was defined as time from anastomosis start until reperfusion. Median AT was 30 minutes. Five-year survival of allografts with an AT >30 minutes was 76.6% compared to 80.6% in the group with AT <30 minutes (p=0.027). Patient survival in the group with higher AT similarly was inferior with 85.7% after five years compared to 86.9% (p<0.0001). Cox regression analysis revealed AT as an independent significant factor for patient survival (HR 1.021 per minute; 95% CI 1.006 to 1.037; p=0.006). As longer AT closely correlates with inferior long-term patient survival, it has to be considered as a major risk factor for inferior long-term results after deceased donor kidney transplantation.This article is protected by copyright. All rights reserved.