Introduction. The aim was to determine the impact of donor glomerulosclerosis on allograft outcome. Methods. The percentage of glomerular sclerosis (%GS) was calculated in protocol biopsies taken at engraftment. Clinical variables were obtained from the Welsh Transplantation Research Group (WTRG) database. Results. Of 210 allografts, 129 showed %GS‫,0؍‬ but 81 kidneys showed %GS between 1 and 60. Patients with %GS‫0؍‬ had the highest glomerular filtration rate (GFR) at 1 year (62.0 mL/min) and

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... he slowest deterioration of function (؊3.8 mL/min per year). Patients with %GS greater than 20 had the lowest GFR at 1 year (36.0 mL/min) and the steepest rate of deterioration (؊9.0 mL/min per year). The %GS of 10 alone can reduce GFR at 4 years by 8 mL/min, a similar reduction to a single rejection episode or an increase in donor age of 30 years. Actuarial 5-year graft survival for %GS‫0؍‬ was 80%, and for %GS greater than 20 was 35% (P‫.)40.0؍‬ Conclusion. The findings indicate that a biopsy taken at procurement will provide information for the most appropriate allocation of a kidney.