Background <p>Complete extrusion of a transplanted kidney through a dehiscent abdominal wound is an extremely rare postoperative complication. While wound-related issues after kidney transplantation are not uncommon, such an extreme event is rarely documented. We present a case illustrating the clinical challenges and management considerations of this complication.</p> Case presentation <p>A 36-year-old woman underwent deceased-donor kidney transplantation. Postoperatively, she developed rapid cardiac arrest, severe neuropathic abdominal pain, and probable Cytomegalovirus (CMV) gastroenteritis. Graft thrombosis was subsequently confirmed, and immunosuppressive therapy was discontinued. Over the following weeks, progressive wound dehiscence with purulent discharge led to complete extrusion of the kidney allograft. An urgent transplant nephrectomy was performed. The patient recovered uneventfully and was discharged on postoperative day four.</p> Conclusion <p>This case underscores the importance of vigilant wound monitoring and multidisciplinary management in transplant recipients, particularly after graft failure and immunosuppression withdrawal. Early recognition of wound compromise and timely surgical intervention are critical to preventing adverse outcomes.</p> Clinical trial number <p>Not applicable.</p>