Objectives To review the outcomes for live donor renal transplantation using kidneys with fibromuscular dysplasia. Methods We performed a retrospective review and searched a departmental database to identify all renal donors with fibromuscular dysplasia from 1995 through 2001. These donors were then paired with the recipient using the institution's renal transplant database. A single radiologist reviewed the original arteriographic studies. Mild disease was defined as mild irregularity of the artery without significant stenosis. Moderate disease was defined as arterial irregularity with less than 50% stenosis. Severe disease was defined as irregularity with greater than 50% stenosis or with aneurysms. Results Thirty-six donor/recipient pairs were identified. Twenty-six donors had unilateral and 10 bilateral disease. Twenty-eight had mild and eight moderate disease. Four grafts were lost during the follow-up period (three acute rejection and one chronic rejection) for an overall graft survival rate of 89%. The median graft survival/follow-up was 37.1 months (range 0.5 to 82). The median serum creatinine was 1.6 mg/dL. The median systolic and diastolic blood pressure was 155 and 82 mm Hg, respectively. Six recipients required no antihypertensive agents. All but 9 of the remaining patients required two or fewer antihypertensive agents. Conclusions Selected patients with medial fibroplasia can be used as renal donors, and satisfactory functional outcomes can be achieved. Renal donors with mild anatomic abnormalities such as medial fibroplasia could be used to increase the potential donor pool and decrease the waiting time for renal transplantation. © 2004 Elsevier Inc.