*Purpose: To investigate the clinical effect of the hypothermic machine perfusion (HMP) method on renal transplantation from high risk donation after citizen death (DCD) and explore the application indication of hypothermic machine perfusion.

*Methods: 104 kidneys from 52 high risk DCD donors performed by single center were included in this controlled trial from December 2011 to July 2017. Every two kidneys from each DCD donor were randomly assigned to HMP and simple cold storage (SCS) group. One-year recipient and graft survival rate, the incidence of delay graft function (DGF), incidence of acute rejection (AR), urine volume and blood creatinine recovery in 14 days after renal transplantation were compared between HMP and SCS group. The index of pressure, flow and resistance were recorded at the beginning and end of HMP.

*Results: One-year recipient and graft survival rates were 98.1% and 92.3% in HMP group and 100% and 96.2% in SCS group respectively after renal transplant which had no statistical difference (P > 0.05). The incidences of AR had no statistical difference between two groups (3.8% vs. 17.3%, P = 0.029). The incidence of DGF in HMP was 3.8% which was significant lower than that in SCS group of 17.3% (P = 0.029). The times of renal graft recovery excluding DGF cases had no statistical difference between HMP and SCS group (7.2±0.62 days vs. 7.7±0.96 days, P = 0.690). During 14 days after renal transplantation, the recipients in HMP group showed advancing peak in dieresis stage and faster reduction of creatinine compared that in SCS group. The renal in HMP group had high flow and low resistance at end of perfusion compared with that at beginning of perfusion.

*Conclusions: HMP significantly decreased the incidences of DGF of renal transplantation from high risk DCD and improved the renal graft recovery. The method of HMP was indication of high risk DCD.

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