The serum creatinine level is one of the earliest metrics of kidney metabolic function. We examined 146 potential donors and their 232 kidney recipients. Donor data included gender, age, cause of death, mean arterial pressure (MAP), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), systemic vascular resistance index, cardiac output (CO), and dopamine consumption. Recipient data were age, gender, time of hemodialysis before transplantation, panel reactive antibodies (PRA), cold ischemia time (CIT), etiology of renal insufficiency, duration/number of postoperative dialyses and serum creatinine levels on posttransplant days 1, 2, 3, 7, 14, 30, 90 and 180 day. Univariate correlates of higher serum creatinine levels in kidney recipients were CIT, time of hemodialysis before transplantation, PRA level as well as donor MAP, CVP, and PCWP. Multivariate analysis revealed that MAP < 70 mmHg in organ donors and CIT > 24 hours contributed to higher serum creatinine levels in kidney recipients up to 14 days posttransplantation (P < .01). There was a significant relation (P < .02) between low donor CO or CVP and an increased recipient serum creatinine level after 14 days posttransplantation. We concluded that decreased donor MAP and prolonged CIT predicted higher creatinine level in kidney recipients in the first 14 days posttransplantation. Donor CO and CVP influenced later serum creatinine levels in kidney recipients.