Background Marginal renal grafts may alleviate the shortage of suitable organs to meet an increasing demand of kidney transplantation,especially when live donors are currently limited to relatives of patients in China.The aim of this study was to investigate how to increase the available donors pool,evaluation,and treatment of marginal donors.Methods We had performed 121 kidney transplantation cases with living relative donors.Five out of these cases applied marginal grafts with surgical diseases,including one renal stone,one duplex kidney,one renal leiomyoma and two cases of simple renal cysts.In each case,particular surgical interventions were exerted on the graft prior to standard engrafting procedures.Results All recipients recovered with functioning transplants given that their serum creatinine levels declined to a normal range within one week after operation.These recipients were subsequently followed up for 10 months on average and their kidney functions remained stable.Conclusions Marginal renal grafts with surgical diseases,which can be treated surgically before engrafting,may provide satisfying transplantation outcomes.Positive and cautious consideration of these grafts may increase renal donorpool.