*Purpose: GFR 1-year after kidney transplantation is a marker for long term graft survival. The aim of this study is to determine the impact of donor acute kidney injury (AKI) on the eGFR at 1 year after kidney transplantation.

*Methods: We included all deceased donor kidney transplants done at our center from 2008 to 2018. We excluded combined organ transplants. We classified the severity of AKI in all donors using the Acute Kidney Injury Network (AKIN) criteria (0 is no AKI to 3 severe AKI). Donor kidneys with more than 10% cortical necrosis or more than mild chronic changes on pre-implantation biopsy were discarded. We also stratified the patients into 3 groups based on the range of the kidney donor profile index (KDPI) of the donor: group 1-donor KDPI < 20%, group 2-KDPI 20 to 85% and group 3-KDPI > 85%. The primary outcome is the influence of donor AKIN on eGFR 1 year after transplant stratified by KDPI range.

*Results: 1,365 kidneys were transplanted from deceased donors during the study period. There was sufficient clinical data available to determine AKIN stage for 1,312 of these kidneys (96.2%) from 973 donors. The AKIN staging for the cohort was AKIN stage 0 (no AKI) in 319 (24.3%), stage 1 in 370 (28.2%), stage 2 in 177 (13.5%) and stage 3 in 447 (34.0%). The KDPI (mean (SD)) for the groups 0 to 3 was 52.9 (27.1), 57.7 (28.7), 51.8 (26.7) and 51.9 (23.2)(p=0.01). Figure 1 shows the mean (mean (standard error)) estimated GFR (eGFR) by CKD-EPI formula stratified by AKIN Group (p=0.002 by ANOVA).

Figure 2 shows eGFR (mean, standard error) for the 4 AKIN groups stratified by the KDPI ranges. In a standard least square analysis the effect analysis for the AKIN grouping was p=0.02 and for the KDPI range the effect was much larger (p<.0001).

*Conclusions: Transplanting kidneys from donors with AKI does not adversely affect the eGFR at 1-year post transplantation even in recipients of higher KDPI donor kidneys.

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