*Purpose: In this study we analyze the SRTR liver data set to determine the trends in machine perfusion of kidney grafts prior to SLK and its effect on graft function.

*Methods: This was a retrospective cohort study of 6,594 SLK recipients between 2005-2020 using the United Network for Organ Sharing database. Differences in recipient and donor characteristics according to use of kidney allograft MPP were compared. Temporal and geographic trends were assessed. Multivariable logistic regression was used to evaluate predictors of MPP. Multivariable logistic regression and Cox regression were used to assess the relationship between MPP and kidney delayed graft function (DGF) and graft survival, respectively.

*Results: Overall, 17% (n=1,134) of SLK kidney allografts were placed on MPP. Nationally, the utilization of machine perfusion in SLK has increased from under 3% in 2005 to 25% in 2020 (Figure 1), however significant center variability exists. Allografts that underwent MPP were older (median 36 vs 34 years old, p<0.01), had a higher incidence of donor diabetes (6.3% vs 4.2%, p<0.01), came from DCD donors (7.9% vs 4.5%, p<0.01), and had longer cold ischemic time (12.9 vs 9.9 hours, p<0.01). However, center preference was the primary determinant of MPP use (intraclass correlation 64%; i.e., only 36% of variability in MPP use was explained by donor or recipient factors). In multivariable analysis, a possible trend towards reduced DGF with MPP was observed (OR 0.81, p=0.08), while adjusted graft survival was not different (HR 0.95, p=0.54).

*Conclusions: Despite increasingly widespread use of MPP for storage of kidney allografts prior to transplantation, this technique does not appear to alter outcomes in simultaneous liver and kidney transplantation.

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