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Background: There are two main techniques for arterial reconstruction in RT: TA using a stab longitudinal incision which creates an elliptical opening and AP which fashions a circular defect. We hypothesized that AP creates a natural anastomosis lumen, similar to the donor renal artery, which optimizes RT perfusion. Methods: A retrospective review of a single‐institution database was performed between 2000 and 2018. Twenty patients who underwent AP arteriotomy were compared to 40 TA‐matched controls. Data were collected on creatinine (preoperative, nadir, and time to nadir), and DUS RI and PSV at 1 week, 3 months, and 6‐12 months post‐RT. Results: ttNC was shorter in the AP group (5 ± 4 vs 12 ± 13 days; P =.03). PSV at 1 week was lower in the AP group (186 ± 65 cm/s vs 232 ± 89 cm/s; P =.04). There was no difference in nadir creatinine value (P =.26), preoperative creatinine (P =.66), and initial postoperative creatinine (P =.80). RI at week 1 were not different between groups (P =.37). Follow‐up DUS showed the difference in PSV between groups became non‐significant (1 month P =.50 and 6‐12 months P =.53). Conclusions: AP arteriotomy in RT improves early perfusion and function parameters (ttNC and initial PSV) as compared to TA. AP arteriotomy optimizes early allograft reperfusion, which may have important long‐term implications and deserves further evaluation. [ABSTRACT FROM AUTHOR]