*Purpose: Kidneys from donation after circulatory death (DCD) donors are more susceptible to cold storage injury and have a high risk of delayed graft function (DGF). This trial is the first to compare normothermic machine perfusion (NMP) to conventional cold storage (CS) in DCD kidney transplantation.

*Methods: In a multicentre randomised control trial, DCD kidneys were randomised to either NMP or static CS. NMP kidneys were perfused for 60min with an oxygenated red cell-based solution (36.0°C) The primary end point was DGF defined as the requirement for dialysis in the first 7 days post-transplant. Secondary outcome measures included rates of primary non function (PNF), duration of DGF, creatinine reduction ratio day 2 (CRR2) and day 5 (CRR5), length of hospital stay, rates of acute rejection, serum creatinine and eGFR at 1, 3, 6 and 12months and patient/graft survival at 12months. For all outcome measures a logistic regression model was used adjusted for cold ischaemic time, donor age, left/right kidney and centre.

*Results: February 2016-March 2020, 338 kidneys were randomised into the trial. Twenty-five kidneys did not undergo NMP due to logistical/technical difficulties but were included in an intention to treat analysis. Twenty-seven kidneys in the NMP and 21 in the CS group did not proceed to transplantation and were excluded; 143 NMP and 147 CS kidneys were analysed. There was no significant difference in the rate of DGF between the groups (EVNP 61% vs CS 58%; P=0.6240). Secondary outcome measures demonstrated a significantly higher CRR2 (P=0.035). There was no significant difference in any other of the secondary outcome measures between the groups.

*Conclusions: A short end period of NMP did not reduce rates of DGF in DCD kidneys. Future research should examine the effects of longer periods of perfusion.

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