Renal transplantation and preservation techniques permit the use of vascular and microvascular surgical procedures for the reconstruction of renal vessels in situations where the size or location of involved renal vessels does not permit the application of standard in situ techniques. Six cases with renal vascular lesions were studied, one each of intimal fibromuscular hyperplasia, medial arterial fibroplasia, renal artery aneurysm, atherosclerosis, iatrogenic arteriovenous fistula, and traumatic venous laceration, that were repaired by ex vivo surgery and autotransplantation under cold storage or continuous hypothermic perfusion protection, which preserved renal tissue. We believe these techniques should be considered before nephrectomy is undertaken, especially in the patient with one kidney.