Introduction: There is increasing evidence for the transplantation of grafts from marginal donors, with centres achieving acceptable short and long term results. The majority of centres decline grafts from patients with renal impairment, despite many of these being young donors in a period of recoverable acute tubular necrosis (ATN). We present our experience transplanting such grafts. Methods: Data for all adult renal transplants between 2000-2011 were collected from a prospectively maintained institutional database. Donors were defined as established renal impairment if they had average urine output < 20ml/hr and creatinine at retrieval >150 umol/L or were requiring haemofiltration. Donors were defined as recovering renal impairment if they had creatinine >150 umol/L but average urine output >20ml/hr. All other cadaveric donors were used as a control group. Donor renal impairment was analysed using Kaplan Meier curves and the log rank test of significance for effect on graft survival (GS) and overall survival (OS). Results: 72 patients received grafts from donors with renal impairment (13 established and 59 recovering renal impairment). 1022 patients were identified for the control group. Median donor age and eGFR was 29yrs (31ml/min), 42yrs (35ml/min) and 48yrs (87ml/min) respectively. DGF rate was 54%, 32% and 23% respectively. Only 1 patient in the established and 1 patient in the recovering renal impairment groups experienced primary non function. There was a non significant increase in LOS in the established renal failure group (median 15 days vs. 10-13 days). 1, 3 and 5yr GS was 92%, 79% and 79% in the established renal impairment group, 90%, 85% and 85% in the recovering renal impairment group, and 92%, 89% and 84% in the control group. There was no significant difference in 1,3 or 5yr eGFR between groups. Conclusion: Contrary to expectation, 46% of grafts from donors with established renal impairment did not have a period of DGF. We have demonstrated that good short and mid-term outcomes can be acheived using grafts from donors with renal impairment. Despite small numbers, the data so far is encouraging for centres selectively accepting these marginal grafts. In our experience, donors with evolving renal impairment can also achieve good outcome, but this group could not accurately be identified retrospectively because this would require serial donor creatinine and urine outputs, which are not routinely recorded prior to retrieval.