*Purpose: The kidneys of deceased donors are often biopsied to evaluate transplant organ quality. A high percentage of GS is a leading cause of kidney discard yet donor GS has failed to predict graft failure and there is limited data supporting the association between IFTA and graft failure. Here we report the effect of donor GS and IFTA on graft survival at a single large OPO.

*Methods: OneLegacy OPO data of deceased kidney donors with kidney biopsy results from 2015-2019 were included and merged with graft outcomes from the OPTN/UNOS data.

*Results: A total of 1,148 deceased donor kidney transplants (DDKTs) were included. The median followed up time was 2 years (IQR 1-3). There were 71 (6.2%) death-censored graft failure. Donors with 0-5%, 6-10%, 11-15%, 16-20%, and >20% GS had 1-year death-censored graft survival (DCGS) of 97.6%, 96.8%, 92.3%, 94.9% and 96.9%, and 3-years DCGS of 93.3%, 92.3%, 91.0%, 90.4% and 91.5%, respectively. Donors without IFTA, mild IFTA, mild to moderate IFTA, and moderate IFTA had 1-year DCGS of 98.4%, 96.4%, 96.4%, and 96.4%, and 3-years DCGS of 97.6%, 91.3%, 96.4% and 88.4%, respectively. After adjusted for kidney donor profile index, only mild IFTA was associated with an increased risk for graft failure at 3-years (aHR 3.54; 95%CI, 1.23-10.15). Donor kidneys with any degree of GS or IFTA had a higher median serum creatinine at 1-year and 3-years followed up compared to those without GS or IFTA .

*Conclusions: Overall donor kidneys with any degree of GS or IFTA have an excellent graft survival. One-year and three years DCGS in kidneys with GS were more than 90%. Kidneys with IFTA had 1-year DCGS more than 95% and 3-years DCGS more than 85%.

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