© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Kidney transplant recipients (KTRs) have greater morbidity and length of stay (LOS) following certain surgical procedures than non-KTR. Given that appendectomy is one of the most common surgical procedures, we investigated differences in outcomes between 1336 KTR and 2 640 247 non-KTR postappendectomy at transplant and nontransplant centers in the United States from 2000 to 2011, using NIS data and adjusting for patient-level and hospital-level factors. Postoperative complications were identified using ICD-9 codes. Among KTR, there were no post-appendectomy in-hospital deaths, compared to a 0.2% in non-KTR (P =.5). Overall complications were similar among KTR and non-KTR (17.0% vs 11.6%; aOR: 0.77 1.12 1.61 ). LOS and costs were greater for KTR compared to non-KTR (LOS ratio 1.19 1.31 1.45 ; cost ratio 1.11 1.17 1.26 ). Only 44.8% of KTR had laparoscopic approach compared to 54.5% of non-KTR, but had similar complication rates (10.6 vs 8.7%, P =.5). When treated at transplant centers, KTR had similar complications (aOR 0.44 0.79 1.43 ), but longer LOS (ratio 1.21 1.37 1.55 ) and greater hospital-associated costs (ratio 1.19 1.29 1.41 ) than non-KTR. Conversely, at nontransplant centers, KTR and non-KTR had similar complications (aOR 0.75 1.23 2.0 ), LOS (ratio 0.84 0.96 1.09 ), and cost (ratio 0.93 1.01 1.10 ). Contrary to other procedures, KTR did not constitute a high-risk group for patients undergoing appendectomy.