*Purpose: The kidney shortage necessitates innovative approaches to expand the donor pool. Acute kidney injury(AKI) is common among deceased donors and a risk factor for discard.

*Methods: Using a comprehensive OPTN and DonorNet dataset, we studied adult kidney-only recipients of donors with AKI between 5/2007-12/2016. DonorNet was used to characterize longitudinal creatinine changes, urine output, and other donor attributes during the terminal hospitalization. Donor AKI was defined as KDIGO AKI stage 1 or higher and terminal creatinine≥1.5mg/dL. Outcomes of kidney transplants from donors with AKI were compared to donors with no/resolved AKI stage 1 and a terminal creatinine<1.5mg/dL (termed the “ideal comparators”). We fit hierarchical linear regression models and proportional hazards frailty models for the primary outcomes of all-cause graft failure(GF) and 12-month estimated glomerular filtration rate(eGFR).

*Results: We identified 7,660 donors with ongoing AKI (33.2% with AKI stage 3, Table 1). Unadjusted rates of all-cause GF within 3 years were similar (15.5% in AKI donors vs 15.1% in ideal comparator, p=0.2, Figure 1). After risk adjustment, there was a slight elevation in all-cause GF among recipients of AKI kidneys (aHR 1.05, 95%CI: 1.01-1.09, Table 2). Mean 12-month eGFR was lower, but differences were not clinically important, among recipients of AKI kidneys (56.6 vs 57.5mL/min/1.73m²; p<0.001). Results were similar after risk-adjustment (Table 2). There were 3,950 discarded kidneys from donors with AKI, age≤65, without hypertension or diabetes, and terminal creatinine≤4.

*Conclusions: Among transplants performed in the US, grafts from donors with AKI have clinically similar graft function and failure rates. Donors with AKI offer an opportunity to substantially expand kidney transplantation.

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