INTRODUCTION AND AIMS: Delayed graft function (DGF) negatively impacts on kidney transplant (KT) outcomes. This study aimed to assess the impact of pulsatile machine perfusion (MP) in kidney transplants performed in a Brazilian region where transplants with standard criteria donors are predominant. METHODS: Prospective cohort including 180 KT performed from Jan/15 to Jul/17, who received paired kidneys from 90 deceased donors in which one underwent MP following static cold storage (CS)

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... ion (MP group) and the other underwent only static cold storage (CS Group). The decision for MP or CS was at discretion of transplant staff. The primary end-point was DGF incidence (requirement for dialysis in the first week after KT) and duration. RESULTS: Donors were young (31613 years), mixed race (80%), non-hypertensive (97%), non diabetic (100%), overweigh (BMI 2664kg/m 2 ), who died due to traumatic brain injury (71%), with final serum creatinine of 1.360.7mg/dL. 95% were standard criteria donors and the mean KDPI and KDRI were 32621% and 0.8660.2, respectively. Custodiol HTK was the solution used in 84% immediately after harvest surgery. There were no differences between groups. Demographic characteristics of the KT recipients were similar in both groups: males (60%), young (41618 years), mixed race (86%), with chronic kidney disease of unknown etiology (38%), and 45645 months on dialysis. However, patients on MP group were more sensitized: panel reactive antibodies (PRA) 18630 vs. 13628% and pre-transplant donor specific antibodies (DSA) 17 vs. 3% (p¼0.005). The total cold ischemia time (TIF) was 2966 vs. 2164h (p<0.001), and dynamic CIT was 1366h. MP significantly reduced the incidence of DGF (30 vs. 53%, p¼0.002), and there was no difference on time on DGF (16620 vs. 13618 days, p¼0.516). CONCLUSIONS: Despite higher immunological risk, patients who received MP kidneys presented lower incidence of DGF. This cohort will be followed to assess the impact of DGF reduction on long-term outcomes.