Objective To investigate the management and clinical effect of accessory renal artery in living-related donor renal transplantation. Methods Clinical data of 277 donors and recipients undergoing living-related donor renal transplantation were retrospectively analyzed. According to the results of preoperative CT angiography (CTA), the donor kidney was selected and the accessory renal artery of the renal graft was treated intraoperatively. Intraoperative status of the donors, and intraoperative management, postoperative complications, clinical prognosis of the recipients were summarized. Results Among 277 cases of renal transplantation, accessory renal arteries were detected in 83 donors by preoperative CTA examination with an accuracy rate of 95%. Fifty-eight donor kidneys with accessory renal arteries were obtained. Twenty-five donor kidneys with accessory renal arteries were reconstructed and anastomized by vascular repairing. Among them, 1 patient presented with anastomotic thrombosis during abdominal closure, whereas the other 24 cases were successfully anastomized with excellent blood flow. No complications, such as hemorrhage, renal graft embolism, ureteral necrosis and urinary fistula, occurred after renal transplantation. The 1-year survival rates of the recipients and renal grafts were 94% and 91%. The clinical efficacy did not significantly differ between the recipients with single renal artery and their counterparts with accessory renal artery (P > 0.05). Conclusions It can be obtained good clinical efficacy of renal transplantation by selecting a suitable donor kidney and reconstructing and anastomizing the accessory renal artery of the renal graft through vascular repair.