BACKGROUND AND OBJECTIVE: Evidence regarding perioperative results and long-term functional outcomes of robotic-assisted kidney transplantation (RAKT) is limited. We evaluated perioperative surgical results and long-term functional outcomes of RAKT in patients receiving kidney transplants from living donors. METHODS: This retrospective analysis is based on a prospective multicenter cohort study conducted from July 2015 to October 2023 across ten European centers. A total of 624 patients who underwent heterotopic RAKT from living donors were included, excluding those who received orthotopic RAKT. The primary outcomes measured were long-term renal function, perioperative complications, and survival rates. Renal function was assessed with the estimated glomerular filtration rate (eGFR). The Clavien-Dindo classification (CDC) was used to describe early (within 30 d) and late (from 31 to 90 d) postoperative complications. The probabilities of dialysis, graft nephrectomies, and any-cause mortality during follow-up were reported in terms of the 5-yr cumulative incidence. KEY FINDINGS AND LIMITATIONS: A total of 624 patients with a median age of 35 yr (interquartile range [IQR]: 26-52) underwent RAKT. Preemptive RAKT was performed in 52% of cases, and the majority (84%) had the transplant in the right iliac fossa. The median operative time was 210 min (IQR: 180-262), with a rewarming time of 43 min (IQR: 38-50). Intraoperative complications were rare (1.1%), and postoperative graft nephrectomy occurred in 1.9% of patients. High-grade (CDC grade ≥3) early and late postoperative complications were observed in 7.7% and 2.3% of patients, respectively. Rates of incisional hernias, ureteral stenosis, and arterial stenosis were 1.4%, 1.1%, and 0.2%, respectively. The median eGFR values were 19, 52, and 53 ml/min/1.73 m CONCLUSIONS AND CLINICAL IMPLICATIONS: With the largest experience worldwide on RAKT, we confirm the perioperative safety and excellent long-term functional outcomes of this procedure. Given the benefits of a minimally invasive robotic approach, these findings support the broader adoption of RAKT as a viable option for kidney transplantation.