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Background:Hypothermic machine perfusion (HMP) is being used more often in cardiac death kidney transplantation;however,the significance of assessing organ quality and predicting delayed graft function (DGF) by HMP parameters is still controversial.Therefore,we used a readily available HMP variable to design a scoring model that can identify the highest risk of DGF and provide the guidance and advice for organ allocation and DCD kidney assessment.Methods:From September 1,2012 to August 31,2016,366 qualified kidneys were randomly assigned to the development and validation cohorts in a 2:1 distribution.The HMP variables of the development cohort served as candidate univariate predictors for DGF.The independent predictors of DGF were identified by multivariate logistic regression analysis with a P ＜ 0.05.According to the odds ratios (ORs) value,each HMP variable was assigned a weighted integer,and the sum of the integers indicated the total risk score for each kidney.The validation cohort was used to verify the accuracy and reliability of the scoring model.Results:HMP duration (OR =1.165,95％ confidence interval [CI]:1.008-1.360,P =0.043),resistance (OR =2.190,95％ CI:1.032-10.20,P ＜ 0.001),and flow rate (OR =0.931,95％ CI:0.894-0.967,P =0.011) were the independent predictors of identified DGF.The HMP predictive score ranged from 0 to 14,and there was a clear increase in the incidence of DGF,from the low predictive score group to the very high predictive score group.We formed four increasingly serious risk categories (scores 0-3,4-7,8-11,and 12-14) according to the frequency associated with the different risk scores of DGE The HMP predictive score indicates good discriminative power with a c-statistic of 0.706 in the validation cohort,and it had significantly better prediction value for DGF compared to both terminal flow (P =0.012) and resistance (P =0.006).Conclusion:The HMP predictive score is a good noninvasive tool for assessing the quality of DCD kidneys,and it is potentially useful for physicians in making optimal decisions about the organs donated.