*Purpose: Kidneys with donor acute kidney injury (AKI) are frequently discarded. We aimed to study the outcomes of A2 incompatible kidney transplantation from donors with AKI as literature about using those kidney in ABOi transplantation is very scarse.

*Methods: Between 5/2015 and 9/2019, we performed 41 A2-incompatible kidney transplants at our institution. A2-incompatible transplantation was performed if pretransplant anti-A2 titers are equal or less than 1/16 and both T and B cell cross-match negative donor-specific-anti HLA-antibodies (DSA) MFI value less than 5000. All patients received anti-thymocyte globulin induction and maintenance immunosuppression with tacrolimus, mycophenolate and prednisone. Patients with pre transplant DSA received IVIG 0.5 mg/kg X 3 doses.

*Results: Out of the 41 patients, 9 patients received kidney with donor terminal creatinine > 3 mg/dL. Of these 9 patients, 77.7% were male, 55.5% African-American, with a median age of 53 (40, 71) years. Median donor age was 36 (26, 55) years, cold ischemia time 32.5 (11.1 ,43.1) hours, median terminal creatinine 4.2 mg/dL (3.6, 5.4) and KDPI 34 (25, 68). 5 patients had both class I and II PRA 0% and 4 patients with PRA > 20%, 3 had pre transplant DSA (1 patients had class I, 1 class II and one patient both class I and II). 8 patients developed delayed graft function. During a median follow-up of 22.5 months (7, 40) patient survival was 100% and graft survival was 100%. None of the patients developed acute rejection The median serum creatinine level at last follow up was 1.3 mg/dL (1.1, 1.5).

*Conclusions: A2-incompatible transplantation appears to be safe with excellent short-term allograft and patient survival in patients receiving kidney with donor AKI if pretransplant anti-A2 titers are equal or less than 1/16. This will help reducing the wait time of blood type B recipients for kidney transplantation.

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