We investigated clinical outcomes of kidney transplantation (KT) from deceased donors with terminal acute kidney injury (AKI) defined acute kidney injury network (AKIN) criteria and expanded criteria donor (ECD). Between February 2000 and December 2013, we performed 202 deceased donor renal transplants from 159 patient defined brain dead in our institution. Of those 159 deceased donor, 38 patients (23.9%) were ECDs and 68 (42.8%) were diagnosed with AKI. According to the ECD and AKIN criteria, we divided 202 recipients into 4 groups: Group I: Non-AKI & SCD (n= 98, 48.5%), Group II: Non-AKI & ECD (n=15, 7.4%), Group III: AKI & SCD (n= 51, 25.2%), Group IV: AKI & ECD (n=38, 18.8%). Among four groups, the incidence of delayed graft function was significantly higher in patient with AKI group than in non-AKI group (6.1%, 0%, 25.5%, 23.7%, respectively, P=0.015). The mean MDRD GFR level at 1month, 6months, 1 and 2years after KT was significantly lower in group IV but MDRD GFR level after 3, 5, 7 10 years did not differ significantly (P = 0.122, 0.708, 0.296, 0.686, respectively). The incidence of acute rejection episodes did not differ significantly among four groups. There were no significant differences among four groups in graft survival (P = 0.074) and patient survival (P = 0.091). In our center, 42.8% of deceased donor was diagnosed with AKI and 23.8% was ECD. Allograft from AKI with ECD donor commonly showed a higher incidence of DGF and lower allograft function for 2 years after KT. Although there is no significant different in graft and patient survival rates, KT from ECD with terminal AKI have to be considered more careful.

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