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In parallel with increased clinical demand, less than optimal or so-called marginal kidney grafts are being used for transplantation. In addition to donor age, it appears that several factors may impact negatively on the quality of the graft. Most importantly, a more precise definition of the term ‘marginal graft’ is needed. The present review analyzes potential risk factors, suggests scoring systems for a more precise definition, and discusses potential treatment options to improve the quality of marginal grafts.