*Purpose: Kidneys from deceased donors with acute kidney injury (AKI) have a higher risk of delayed graft function (DGF). The aim of this study was to determine the impact of the severity of donor AKI on the outcomes from DGF.

*Methods: We included all deceased donor kidney transplants done at our center 2008 to 2018. Combined organ transplants were excluded. Severity of AKI in all donors was classified using the Acute Kidney Injury Network 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. The primary outcome was to analyze the impact of DGF on graft survival after adjusting for donor AKI (AKIN stage).

*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%). DGF occurred in 44.6% and 75.4% of AKIN 2 and 3 groups as compared to 33.9% and 33.5% in AKIN 0 and 1 (p<.001). There was no difference in overall graft survival between the AKIN groups; however, the graft survival was lower for the cohort with DGF (log rank p-value=0.01 and Wilcoxon p-value=0.002).

In a model including recipient age, KDPI>85% and AKIN stage, DGF was associated with higher risk of late graft loss (HR 1.71, 95% CI 1.28-2.27) however the impact of DGF on graft survival was less in the higher AKIN stage groups.

*Conclusions: These results show that the risk of DGF is substantially higher with transplanting kidneys from donors with AKI; however, the impact of DGF on graft survival does not appear to be directly related to the severity of the donor AKI.

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