*Purpose: To study outcomes of deceased donor kidney transplantation (DDKT) in recipients of kidney allografts with poor perfusion parameters.

*Methods: This is a retrospective, single center study of patients who underwent DDKT at a large volume transplant center between January 1996 and November 2017. Recipients of kidney allografts that had marginal perfusion parameters, defined as pump flow rate (F) <70ml/min or Resistance Index (RI) >0.4 prior to the allografts being taken off pump, were included. Kidney pump parameters, recipient and donor demographics, terminal creatinine, pre- and post- transplant recipient serum creatinine (SCr), SCr at 1-year after transplant, any episodes of rejection, cold ischemia times (CIT), and delayed graft function (DGF) were examined. Pediatric recipients (<18y), multi-visceral transplants, and living donor recipients were excluded. Primary end point was graft survival at 1-year post-transplant.

*Results: One thousand nine hundred sixty-eight patients) underwent DDKT from January 1996 to November 2017; 32 (1.62%, 15 females, 17 males) recipients received kidney allografts with a RI >0.4 and pump flow rate <70ml/min, with a median recipient age of 56 years (Q1,Q3: 50, 64). Median donor age was 46 years (34, 54), with median terminal creatinine 0.925 mg/dl (0.69, 1.55) and cold ischemia time of 10.38 hours (8.05, 13.78). Three were donation after cardiac death donors. Median RI and flow rates were 0.471 (0.43, 0.53), and 60 ml/min (54, 67). Median recipient serum creatinine was 4.14 (2.19, 5.53) on POD 5, and was 1.84 (1.41, 2.3) at 1-year follow-up. DGF rate was 18.5% (5 of 32 recipients) and primary non-function was noted in one. Over one-year follow-up rejection was noted in and 18.75% (6 of 32) recipients. Graft survival was 81% at the one-year follow-up.

*Conclusions: Carefully selected kidney allografts with marginal perfusion parameters can be used for transplantation and this can somewhat help in organ shortage.

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