The transplantation of vascularized organs requires discontinuation of the organ blood supply. Ischemia-reperfusion injury is a serious issue in organ transplantation, bearing the potential to shorten graft and patient survival. It can affect early and late posttransplant kidney allograft function and is caused by numerous factors, including reactive oxygen species generation, aberrations of intracellular calcium concentration, activation of mononuclear cells, endothelial cells damage, capillary obstruction and the no-reflow phenomenon. During this period, biochemical and inflammatory events occur within the tissue, leading to graft dysfunction. This multifactorial process can be targeted by therapeutic interventions. In this paper, current data on the therapy and prevention of ischemia-reperfusion injury in renal transplantation is presented. The use of antioxidants, enriched preservation solutions, calcium channel blockers, factors limiting lipid peroxidation, inhibition of neutrophil-mediated acute inflammation, and immunosuppressive agents, as well as ischemic preconditioning or pulsatile perfusion can be proposed to prevent graft damage.