*Purpose: Deceased donor kidneys damaged surgically during procurement are often discarded. Because of the critical shortage of available kidneys for waitlisted ESRD patients, our center works to accept such kidneys when Organ Procurement Organizations (OPO) cannot place them elsewhere and reconstruct prior to transplant.

*Methods: We reviewed 27 consecutive imported kidneys with surgical damage successfully reconstructed and transplanted at our center from October 2016 through March 2019. Reconstruction technique was described. Incidence of post-surgical complications were compared using Fisher’s Exact Test. Death-censored graft survival was assessed using the method of Kaplan and Meier. eGFR by MDRD equation at one year was compared in the reconstruction group to other imported kidneys from the same time period with sufficient follow-up using t-test comparison of means.

*Results: 9/27 required reconstruction, using extension iliac arterial allografts from cadaveric donors of the same blood type; and refashioning of the aortic patch in multiple arteries; 12/27 cases, repairs for injuries to the smaller segmental/polar arteries; 6 cases, a combination of the above techniques. Surgical complication rates were no different between the repaired kidneys and other imported kidneys. One-year death-censored graft survival was 96.3% (SE: 0.0363, CI: 76.4%-99.47%). A single graft failure occurred at 221 days and was due to APRT deficiency with 2,8 DHA intratubular crystals and so considered unrelated to the surgical damage or reconstruction. eGFR at one year in recipients with survival with function and follow-up at one year had a mean of 48.7 in the reconstructed kidneys compared with 56.1 in 231 other imported kidneys from the same period. This difference was not significant (p=0.2167). Kidneys requiring repair were not correlated with KDPI, final pump resistance, or % glomerulosclerosis on biopsy, but was associate with longer cold ischemic time (table 1).

*Conclusions: Given the critical shortage of available kidneys for transplant, transplanting kidneys that might otherwise be discarded is essential. We have shown that kidneys with surgical damage that can be successfully reconstructed can be transplanted with good outcomes. The need to reconstruct the kidneys may slightly increase cold ischemic times, but that does not prevent successful transplantation with good function.

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