*Purpose: With the growth of marginal deceased donor (DD) kidney utilization, machine preservation or “pumping” of selected kidneys has become an increasingly important part of the management algorithm. Although many centers will consider transplanting kidneys from marginal DDs, poor pump parameters (PPs) remains a major reason for either delay in kidney placement or kidney discard following organ recovery. The study purpose was to review retrospectively our experience with transplanting kidneys from DDs with poor PP.

*Methods: Poor PPs were defined as a terminal flow <80 ml/min AND a terminal resistance ≥0.4 mm Hg/ml/min. Dual kidney and multi-organ transplant recipients were excluded. All patients received depleting antibody induction and triple maintenance therapy (FK, MPA, steroids).

*Results: From 4/02 to 9/21, we transplanted 91 kidneys with poor PPs including 27 (30%) from standard criteria donors, 32 (35%) from donation after cardiac death donors, and 32 (35%) from expanded criteria donors. Mean donor age was 46.7 years, mean Kidney Donor Profile Index (KDPI) was 66%, and 50 kidneys (55%) were imported from other donor service areas. Mean DD terminal serum creatinine (SCr) was 1.16 mg/dl. Mean cold ischemic time (CIT) was 26.2 hours (27 patients [30%] had a CIT ≥30 hours) and mean pump time was 12.7 hours. Mean terminal pump flow was 65 with a resistance of 0.48. Mean recipient age was 55 years and 62 patients (68%) had at least 5-years follow-up. This poor PPs group was compared to 647 concurrent control patients receiving kidneys from DDs with excellent PPs defined as a flow ≥120 (mean 150) AND a resistance ≤0.20 (mean 0.15). Mean donor and recipient ages in the control group were 44.5 and 54 years, mean KDPI was 56%, mean CIT was 24.9 hours, and mean pump time was 12.2 hours. The incidence of delayed graft function (DGF) was 37% poor PPs vs 30% in controls (p=0.18) whereas the incidence of primary nonfunction (PNF) was 5.5% poor PPs vs 2.2% controls (p=0.07). One-year patient and kidney graft survival rates (GSR) were 95.6% vs 97.4% and 91% vs 93% (both p=NS) in the poor PPs vs control groups, respectively. Mean one-year SCr and GFR levels were 1.9 vs 1.7 mg/dl and 40 vs 51 ml/min/1.73m² in the poor PPs and control groups, respectively. With a mean follow-up of 67 months, overall patient and kidney GSRs were 58% vs 70% (p=0.055) and 46% vs 57% (p=0.03) in the poor PPs vs control groups, respectively. Actual 5-year death-censored kidney GSRs were 62% poor PP vs 79% in controls (p=0.20).

*Conclusions: In the setting of a slightly higher incidence of DGF and PNF, patients receiving kidneys from DDs with poor PPs have acceptable albeit inferior medium-term outcomes compared to those receiving kidneys from DDs with excellent PPs. Although a negative selection bias may exist for DDs with poor PPs (higher donor age, KDPI, and CIT), poor PPs alone should not be a contraindication to kidney utilization.

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