When renal transplant recipients undergo aortic surgery, blood supply to the renal graft is interrupted while the aorta is clamped. Several innovative ways of using shunts have been described to preserve blood flow to the transplanted kidney during such surgery on the assumption that temporary warm ischemia of the renal transplant is poorly tolerated. We have performed aortic surgery in four renal transplant recipients without the use of any form of graft protection. One patient underwent urgent operation to treat an expanding aortic aneurysm and the other three had elective surgery for aortoiliac occlusive disease. Ischemic times ranged from 30 to 45 minutes. Two of the four patients had a temporary rise in serum creatinine levels. No patient required hemodialysis. We conclude that in selected renal transplant recipients, aortic surgery can be safely undertaken without graft protection.