(Received 12 September, 2009 ; Accepted 23 December, 2009)AbstractBackground and purpose: We evaluated outcome of transplantation in donors MRAs that underwent multiple anastomosis in recipient, according to graft function, survey of graft and recipient, hypertension before and after transplantation, and surgical complications, comparable with single renal artery and MRA that was converted to a single artery before transplantation.Materials and methods: In this case series study, from March 2003 to March 2009 in our kidney transplantation center, 7 renal grafts with MRAs underwent multiple anastomosis between renal arteries and recipient internal and external iliac and inferior epigasteric arteries. Single renal artery and multiple renal arteries that were converted to a single artery before transplantation, were excluded.Results: Excellent perfusion was observed in renal graft after removal of vascular clamps in all cases. Convenient diuresis with average of 13444 cc in first day after transplantation was instituted. Post transplantation hypertension did not occur. All of recipients had a normal serum creatinin level with mean range 1.3 mg%. We observed perinephric collections in 2 recipients. One of collections was lymphocele and second one reported degenerated hematoma. Both collections were treated with aspiration. Isotopic scan and grafts ultrasonography indicated good survey and function of allografts.Conclusion: We observed graft function, graft and recipient survival, intra and post operative complication, preoperative and post transplantation hypertension in our procedure similar to renal transplantation with single renal artery and MRA that was converted to single artery, because total ischemic time (TIT) was decreased in our option. We believe our procedure is a good alternative for bench surgery in MRA.J Mazand Univ Med Sci 2009; 19(73): 76-79 (Persian).