Between 1970 and 1990 renal transplantation was performed in 16 patients with a history of posterior urethral valves. While 10 patients had undergone supravesical urinary diversion before the development of end stage renal disease, all but 1 transplant were drained to the unaugmented native bladder. The 2 and 5-year graft survival rates were 70% and 59%, respectively. Of the 15 surviving patients 11 have allografts that are functioning at a mean of 86 months after transplantation with a mean serum creatinine of 2.0 mg./dl. Urological complications occurred in 19% of the transplants. No detrimental effect of the valve bladder on long-term allograft survival or function was apparent. With appropriate treatment of vesical dysfunction, these patients can be expected to have graft function comparable to the general transplant population despite use of the unaugmented native bladder.