Immediate renal allograft function following kidney transplantation is most desirable. Cold storage is associated with a significant amount of early post-transplant renal dysfunction. While pulsatile perfusion is more costly and technically demanding for preservation of renal allografts, a significant reduction in the need for post-transplant dialysis with concomitant shorter hospital stays for transplanted patients, offsets the moderately increased costs of preservation. In this study we aimed to evaluate the benefits and outcome of perfusing a kidney for transplant. There were 112 harvested kidneys that were pumped from June 2001 to Aug. 2003, of which 59 were transplanted at our Hospital, 30 kidneys discarded, and the remainder distributed to other transplant centers. No kidneys in this study were discarded due to lack of availability of a suitable recipient. UW perfusate solution was used. The data for the pumped group was provided by One Legacy, an organ procurement organization in Southern California. The control group consisted of 261 cadaveric non-pumped, transplanted kidneys transplanted during the same period. Statistically there were no significant differences between the two groups in donor age, gender, mismatch, and donor cause of death. Patient & graft outcome is divided into: pumped group (n=59) vs. control group (n=261) respectively. Immediate functioning: 41(69.5%) vs. 127(48.7%), P=0.02; DGF: 9(15.3%) vs. 114(43.7%), P=0.09; primary non-functioning: 7(11.9%) vs. 11(4.1%), P=0.03; length of stay: 9.7+/-9.6 vs. 9.4+/-3.0, P=0.69; Graft survival at 6 months: 88.1% vs. 90%, P=0.63 & 1 year: 81.3% vs. 85.0%, P=0.44; Patient survival at 6 months: 96.6% vs. 95.7%, P=0.74 & 1 year: 90.0% vs. 93.1%, P=0.43. Cadaver renal preservation using pulsatile perfusion with UW has lowered the incidence of post-transplant DGF due to preservation injury from 29.1% to 15.3%. The rate of primary non-functioning in the pumped group was 11.9% vs. 2.7% in the control group. Although use of pump preservation was primarily for marginal donor kidneys, the outcome was comparable to the control group. Pulsatile preservation helped to identify high risk kidney for primary non functioning kidneys by using pump pressure and resistance index criteria.