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Objective To evaluate the clinical effect of hypothermic machine perfusion (HMP) in the storage of renal grafts from deceased donor (DD) with high-risk delayed graft function (DGF). Methods Clinical data of 52 donors with high-risk DGF were collected in this prospective randomized controlled study. Two renal grafts from each donor were randomly divided into the HMP group («=52) and static cold storage (SCS) group (n=52). In the HMP group, the renal grafts were stored by LifePort under HMP, whereas the renal grafts in the SCS group were preserved in University of Wisconsin solution (UW solution). The incidence of DGF and primary nonfunction (PNF) after renal transplantation was statistically compared between two groups. The recovery of renal graft function, the survival rates of the recipients and renal grafts within postoperative 1 year were observed in two groups. Results The incidence of DGF in the HMP group was 4%(2/52), significantly lower than 17% (9/52) in the SCS group (.P<0.05). No PNF was reported in the I IMP groupand 1 case of PND was noted in the SCS group, the difference was not statistically significant (P>0.05). The recovery time of graft function of the recipients in the HMP and SCS groups were (7.2 ± 0.6) d and (7.7 ± 1.0) d with no statistical significance (/f>0.05). In the HMP group, the urine volume of the recipients on the day of operation, postoperative 1 and 2 d was significantly larger than that in the SCS group (all .P<0.05). In the HMP group, the levels of scrum creatinine at each time point after operation were significantly lower than those in the SCS group (all .P<0.05). The 1-ycar survival rates of the recipient and kidney were 98.1%, 92.3% and 100%, 96.2% in the IIMP and SCS groups with no statistical significance (all F^O.05). Conclusions IIMP can significantly reduce the incidence of DGF after renal transplantation from DD with high-risk DGF and promote the early recovery of graft function. [ABSTRACT FROM AUTHOR]