*Purpose: Demonstrate the utility of fluorescent imaging to assess the perfusion of a kidney transplant, after a vascular complication, requiring complex reconstruction.

*Methods: Case report.

*Results: We present a case of a 65 year female, with history of end stage renal disease secondary to lupus. She also had history of atrial fibrillation, requiring anticoagulation therapy. She underwent standard deceased donor kidney transplant. The allograft was a left kidney, with 2 renal arteries. Postoperative course was complicated with bleeding requiring re-exploration. An injury to the superior pole artery was noted which required its ligation. Fluorescent imaging was used to assess perfusion of the superior pole. The superior pole showed delayed and heterogeneous enhancement of the parenchyma, consistent with decreased perfusion. The decision was made to proceed with explanation of the allograft, backtable vascular reconstruction and re-implantation. Immediately after reperfusion fluorescent imaging was performed. Homogeneous and intense enhancement of the parenchyma was noted with resolution of ischemic areas. Perfusion was also assessed with hand held Doppler which correlated with the imaging findings.

*Conclusions: Fluorescent imaging is a feasible and safe tool for assessment of intraoperative perfusion in kidney transplantation. It may be especially beneficial in cases were complex vascular reconstructions are required, and when suspicion of regional organ hypoperfusion is suspected.

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