Microvascular reconstruction was performed ex vivo on 50 kidneys that had vascular anomalies or had sustained vascular injury during procurement before allograft transplantation or autotransplantation. The authors review the various surgical techniques used to facilitate the in-situ vascular anastomoses during transplantation and to salvage otherwise an unusable allograft. The complications associated with the microvascular repair were negligible. The authors conclude from the results of their study that ex-vivo microvascular reconstruction is a valuable adjunct to renal transplantation.