The complications of ureteral ischemia make revascularization of polar vessels attractive in cadaver and live-related transplants. Patients (32) underwent reconstruction of polar vessels of 1.2-2.5 mm in diameter after revascularization of the major vessels as follows: inferior epigastric artery to polar artery, 10 patients (6 cadaver transplants and 4 living-related transplants); polar vessel with a patch of aorta to iliac artery, 1 patient (living related donor); polar artery to the main renal artery or branch, 17 patients (14 cadaver transplants, 3 living-related transplants); autogenous saphenous vein graft, 2 patients and 1 child receiving an adult live-related kidney and 1 cadaver transplant with 3 arteries and a stenosis of the inferior polar vessel; polar artery to vein patch in iliac artery, 2 patients (cadaver transplants). Follow-up was done by arteriography (18 patients), direct observation (2 patients) and by use of ultrasound (1 patient). The remaining 11 patients exhibited no evidence of occlusion. Twenty of 21 patients exhibited patent vessels; 1 thrombosed at the time of the transplant operation. Long-term patency in the patients studied was 95%. Small-vessel reconstruction in human renal transplantation, either during ex vivo preservation (workbench surgery) or at the time of transplantation is advocated.