The metabolic consequences of low-temperature kidney preservation were investigated. A comparison was made between kidneys which were immediately preserved and kidneys which had been ischemic for 1 hour. Two types of preservation techniques were used: (1) continuous perfusion with oxygenated plasma as described by Belzer and (2) a single flush with potassium-containing perfusate as suggested by Collins. Slices of renal cortex were removed at varying times during preservation and analyzed for a variety of metabolic intermediates. ATP levels were markedly reduced from normal. The Belzer technique was associated with higher ATP levels and ischemia lowered the ATP level. Kidneys perfused by the Belzer technique had lower ADP levels than those by the Collins method. Preservation caused marked elevation of tissue lactate, irrespective of ischemia or the technique used. We conclude that low temperature kidney preservation has profound effects on cellular metabolism. Therefore, the measurement of metabolic intermediates may provide a rational approach to the prediction of organ survival.