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Objective: Phenylephrine administration is one strategy to maintain renal perfusion during postoperative hypotension following renal transplantation. However, its effect on the renal allograft is unknown. We evaluated the safety and efficacy of this approach. Design: A retrospective cohort study comparing a phenylephrine treatment group to a matched control group. The following statistical tools were used: Student’s t-test for continuous data, Chi squared for categorical data, a non-linear mixed decay model for change in creatinine over time, a Pearson correlation plot of change in creatinine to phenylephrine, and Kaplan-Meier for graft survival. Setting: A tertiary care hospital. Patients: Of 307 renal transplant recipients between November 2005 and October 2011, 75 required phenylephrine, including 46 deceased donors (DDRT) and 25 living (LDRT). These were compared with 75 matched controls. Interventions: Phenylephrine administration. Main Outcome Measures: Rate of delayed graft function (DGF) and serum creatinine. Results: One LDRT and 15 DDRT requiring phenylephrine developed DGF versus 10 controls (RR=1.8, CI 0.89-3.63, p=0.10). There were no significant differences in number of dialysis treatments required (mean: treatment group=2.7, control=3.4). No significant long-term renal function (POD 30, 60, 365 creatinine; p>0.079) or graft survival differences were observed. The normalization of creatinine was slower in the phenylephrine group (p<0.0001), but no difference in creatinine was noted prior to discharge. Conclusions: While there is a brief association between phenylephrine administration and slower transplanted kidney recovery, there is no significant impairment in the treatment group at time of discharge. Administration of phenylephrine to patients after renal transplant appears safe.