*Purpose: Both microscopy and kidney donor profile index (KDPI) scoring systems have been used to predict kidney transplant outcomes. Utilizing gross renal morphology, we designed a simple morphologic scoring system to help predict the kidney transplant outcomes in terms of immediate graft function, delayed graft function and primary non-function.

*Methods: A Single center pilot study based on the morphology of the deceased donor kidneys was developed. The score is based on the anomalies of the kidney (scarring or cysts), the condition of the renal artery and aortic patch (atheroma), the consistency of the kidney (fibrosis) and the presence of sticky fat on the kidney. Each category was assigned a score of 0 (none) to 2 (severe) before transplantation, and given a total score out of 8.

*Results: We included 62 recipient who received kidneys from 57 deceased donors. Kidneys with a score ≥1.5 had higher rate of delayed graft function (DGF) compared to those with a score of <1.5 (p = 0.00041). Specifically, DGF occurred more frequently in kidneys with sticky fat (p= 0.018), as well as fibrous consistency of the kidney (p= 0.0013), but we did not show any association with atherosclerosis or renal anomaly. The one patient with primary non-function had a score of 4.5/8.0. KDPI score of > 40 was associated with higher rate of DGF (p = 0.0048) whereas Remuzzi scores was unable to predict DGF rates.

*Conclusions: Gross kidney morphology can help to predict DGF. However, greater numbers and longer follow-up are needed to establish an association between the gross morphology scoring system and long term graft function and survival.

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