Pulsatile preservation of cadaveric kidney allografts allows effective organ preservation and the opportunity to obtain information about the quality of the organ during storage. The use of information obtained by measuring FLOW (ml/min) and renal resistance (mean perfusion pressure/FLOW (ml/min)) while kidneys are undergoing pulsatile perfusion offers quantitative data to determine suitability of an organ for transplant. This may be more accurate than the combination of demographic variables with past and current medical information that has been traditionally used to evaluate donor suitability. We have evaluated 82 kidneys that received a period of pulsatile preservation at our institution. Kidneys were from consecutive donors age > or = 42 years and were stratified into three high risk groups: donor age > or = 60 (48%), the presence of hypertension (52%), and IMPORT kidney (48%). All IMPORT kidneys were obtained through UNOS after the local center considered them unacceptable for transplant and none were 6-antigen match organs. Kidneys were discarded if they failed to have a FLOW > or = 70 ml/min or RR < or = 0.4. Twelve kidneys (15%) failed to meet these criteria and were discarded. All 12 kidneys were from donors age > or = 60 (p = 0.002). The average FLOW and RR of transplanted kidneys was 103 ml/min and 0.3283 respectively. Six of 69 (8.6%) transplanted organs required dialysis (ATN). No pump parameters predicted the development of ATN although 5 of 6 kidneys were IMPORTs. Recipient outcome data, including 72-hour urine output and day 10 serum Cr, were affected by organ risk group, but these did not impact on patient care.(ABSTRACT TRUNCATED AT 250 WORDS)