One of the most enduring truisms in transplantation of all organs was written by Starzl almost 60 years ago: “The provision of a viable and minimally damaged homograft is undoubtedly the most important single factor in the determinant of success.”1 Presently, there are far more patients in need of transplant than there are organs available, and the use of expanded criteria donors has become an important source of organs for an ever-increasing acuity of patients. Consequently, the specter of graft failure and the ability to assess and predict outcomes to better intervene with management strategies has become the frontier in transplantation.