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Adipocyte fatty acid-binding protein (A-FABP) is abundantly found in mature adipocytes and is involved in cardiovascular disease. Our aim is to investigate the association between serum A-FABP levels and endothelial function among kidney transplant (KT) patients. Fasting blood samples were obtained from 80 KT patients. Serum A-FABP levels were measured using a commercially available enzyme immunoassay kit. Endothelial function and vascular reactivity index (VRI) were measured using digital thermal monitoring test. In this study, VRI &lt; 1.0, VRI 1.0&#8722;1.9, and VRI &#8805; 2.0 were defined as poor, intermediate, and good vascular reactivity, respectively. There were 12 (15.0%), 30 (37.5%), and 38 (47.5%) KT patients categorized as having poor, intermediate, and good vascular reactivity, respectively. Increased serum levels of alkaline phosphatase (<i>p</i> = 0.012), &#947;-glutamyltranspeptidase (GGT; <i>p</i> = 0.032), and A-FABP (<i>p</i> &lt; 0.001) were associated with decreased vascular reactivity. Multivariable forward stepwise linear regression analysis revealed that age (&#946; = &#8722;0.283, adjusted R² change = 0.072; <i>p</i> = 0.003) and serum log-A-FABP level (&#946; = &#8722;0.514, adjusted R² change = 0.268; <i>p</i> &lt; 0.001) were significantly associated with VRI values in KT patients. We concluded that serum fasting A-FABP level is negatively associated with VRI values and plays a role in endothelial dysfunction of KT patients.