Adenosine receptor antagonists, especially aminophyllline, are used to treat or prevent acute renal failure. In the preferred embodiment, aminophylline is administered by infusion so that it does not exceed a serum theophylline level of 15-20 micrograms/ml, most preferably the aminophylline is administered to achieve a serum theophylline concentration of 3-10 micrograms/ml, with an infusion rate of 0.1-0.6 mg/kg IBW/hour (IBW=ideal body weight). The adenosine receptor antagonist can also be used to help sustain a kidney for transplant purposes. Preferably, aminophylline is loaded while the kidney is still part of the donor. A dose of aminophylline of 5 mg/kg lean body weight is infused into the donor over a 30-60 min period, with cardiac monitoring. The infusion dose is decreased in the event of supraventricular or ventricular tachycardias. The kidney is removed and placed in the standard "cold" bath, but containing aminophylline at a dose of 5-10 micrograms/ml (5-10 mg/l). The kidney is then transported to the recipient. The recipient is similarly preloaded with 5 mg/kg lean body mass aminophylline intravenously over 30-60 min with cardiac monitoring, with a constant infusion of 0.1-0.3 mg/kg lean body mass/hr continuing during the next 24 hours after the kidney is transplanted into the recipient.