Background: The impact of sugammadex in patients with end-stage renal disease undergoing kidney transplantation is still far from being defined. The aim of the study is to compare sugammadex to neostigmine for reversal of rocuronium- and cisatracurium-induced neuromuscular block (NMB), respectively, in patients undergoing kidney transplantation.Methods: A retrospective, observational study was performed. A total of 350 patients undergoing kidney transplantation, equally divided between a sugammadex group (175 patients) and a neostigmine group (175 patients), were considered. Postoperative kidney function, evaluated by monitoring of serum creatinine and urea and estimated glomerular filtration rate (eGFR), was the endpoint. Other endpoints were anaesthetic and surgical times, post-anaesthesia care unit length of stay, postoperative intensive care unit admission, and recurrent NMB or complications.Results: No significant differences in patient or, with the exception of drugs involved in NMB management, anaesthetic and surgical characteristics were observed between the two groups. Serum creatinine (median [interquartile range]: 596.0 [478.0-749.0] vs 639.0 [527.7-870.0] μmol/L, p=0.0128) and serum urea (14.9 [10.8-21.6] vs 17.1 [13.1-22.0] mmol/L, p=0.0486) were lower, while eGFR (8.0 [6.0-11.0] vs 8.0 [6.0-10.0], p=0.0473) was higher in the sugammadex group than in the neostigmine group after surgery. The sugammadex group showed significant lower incidence of postoperative severe hypoxemia (0.6% vs 6.3%, p=0.006), shorter PACU stay (70 [60-90] min vs 90 [60-105] min, p<0.001), and reduced ICU admissions (0.6% vs 8.0%, p=0.001).Conclusions: Compared to neostigmine for reversal of NMB, sugammadex resulted in a better recovery profile in patients undergoing kidney transplantation.