Objectives: Commercial kidney transplantation has grave consequences. We aimed to assess the complications and outcomes of the commercial transplants undergoing follow up at our center. Methods: We conducted a retrospective review of all adult KTRs transplanted commercially overseas from unrelated donors (Jan 2020 -September 2023), then presented to our Center for post-transplant follow-up. Results: Fifty-eight KTRs were identified, 40 men (69 %). The median age at transplantation was 36 years (IQR 30-45). All patients received their kidneys in Pakistan and presented on a median of day 5 (IQR 3-5) post-transplant. Upon presentation, 35/58 (60.3%) indicated hospitalization for a median of 10 days (IQR 5-30 days), and 13 (22.4%) suffered delayed graft function. Patients were followed up for a median of 14.5 months (IQR 7-17 months). Median creatinine at presentation was 161.5 mmol/l (IQR 117.25 – 440.5), improved to 105 (89.75-125.5) by the end of 1st year and stabilized at 107 (86-126.75) mmol/l at the end of follow up. 48 rejection episodes occurred in 33 KTRs (56.9%), 27 of them in 25 patients within the 1st post-transplant month. Urinary tract infection affected 22/58 patients, addition to 4 patients having epididymo-Orchitis. Surgical site infection affected 8 patients. Newly acquired HCV infection was detected in 2 and HIV in one, while CMV viremia was detected in 15 KTRs. Plasmodium falciparum infection was encountered in 2 patients and Fungal infection in 7 (candida in 5 and aspergillosis in 2). Urologic complications affected 37/58 patients (ureteric stenosis in 10 and urinary leak in 7). This indicated nephrostomy in 13 and perinephric fluid drainage in 8 KTRs. The mortality rate was 5.17% (3/58), and the death-censored graft loss was 4/58 (6.9%). Conclusions: Commercial kidney transplantation entails a complicated post-transplant course with high rates of interventions, mortality, and graft loss. All efforts must b exerted to combat commercial transplant practices.