BACKGROUND: A steno-occlusive disease of the iliac artery can mimic renal vascular hypertension, and is an important cause of renal dysfunction in renal transplant recipients. We assessed the alternation of postanastomotic arterial blood flow of lower extremities by ankle-brachila index (ABI). METHODS: We analyzed 50 patients who underwent kidney transplantation between March, 2010 and November, 2012 at Chonnam National University Hospital. This study was performed prospectively and case selection by renal transplantation patients who got first operation on right iliac fossa. All operational procedures were end to side anastomosis of the external iliac artery to the renal artery. We measured and compared the preoperative and postoperative (1 week, 6 months, 1 year) ABI. We analyzed the diameter of the recipient external iliac artery and renal artery of the transplanted kidney. RESULTS: Among 50 patients, 34 were male (68%) and 16 were female (32%). The mean age of recipients was 44.37+/-11.42 years. The mean preoperative ABI at the right lower extremity was 1.17+/-0.11, postoperative 1 week, 6 months, and 1 year was 1.14+/-0.10, 1.15+/-0.11, 1.17+/-0.15, respectively. Alternation of preoperative ABI and postoperative 1 week, 6 months, and 1 year was P=0.331, P=0.864, and P=0.992, respectively. CONCLUSIONS: Alternation of ABI on the ipsilateral lower extremity was not significant in renal transplanted recipients. We recommend a long-term study with more cases.