A group of 40 cadaveric kidneys was studied just prior to planned transplantation to further assess the applicability of31P-MRS in the analysis of clinical renal transplant viability. Renal intracellular high-energy phosphorus metabolites (ATP [or NADP], phosphomonoester [PME] and inorganic phosphate [Pi]) and pH were measured noninvasively with MRS surface coils external to cold storage containers.Pretransplant MRS parameters were correlated with subsequent renal function in recipient patients (measured one week postoperatively by the need of dialysis, drop in serum creatinine, urine output, and123I or131I Hippuran assessed renal tubular function).ATP and NADP was detected in eleven kidneys and was significantly (P<0.001) associated with the best renal function posttransplantation. These kidneys also had the highest PME/Piratios (1.66–0.54), while lower ratios (0.36–0.10) were associated with prolonged acute tubular necrosis. The PME/Piratios significantly (P<0.0001) correlated with subsequent clinical renal function, whereas cold storage times (37±10 hr) or intracellular renal pH (6.53–7.91) did not.These preliminary data suggest that MRS is a noninvasive, nondestructive and sterile method for assessing clinical viability during hypothermic storage of human cadaver kidneys and the subsequent recovery of renal function postrenal transplantation.