*Purpose: Kidneys with donor acute kidney injury (AKI) are discarded at a higher rate. The purpose of the study is to assess long term renal allograft outcomes in deceased donor renal transplants with donor acute kidney injury (AKI) across different KDPI groups.

*Methods: All adult primary solitary kidney deceased donor transplants (DDRT) performed between 2008 and 2018 reported to the UNOS/OPTN database were analyzed. Based on terminal donor serum creatinine, the cohort was divided into 2 groups, serum creatinine <2mg/dl and >=2 mg dl. Renal allograft survival rates were computed according to Kaplan-Meier and Cox proportional hazards were used to estimate the impact of potential influential variables.

*Results: In this cohort,the number of kidneys transplanted with terminal donor serum creatinine <2mg/dl were 74,900 and for donor creatinine >=2 mg/dl were 8825. Rates of delayed graft function were higher in group2 (39.4%-48%) as compared to group1(14.1%- 32.6%) across KDPI categories. For group1,donor serum creatinine <2 mg/dl , one and five-year renal allograft survival were (96.3%, 83.4%) for KDPI < 20,(95%,80.5%) for KDPI 30-34,(94.4%,77.8%) for KDPI 35-49 ,(92.7%,73.6%) for KDPI 50-79 and (88.5%,63.7%) for KDPI >80. For group 2, donor serum creatinine >=2 mg./dl,one and five-year renal allograft survival were (97%,82.9%) for KDPI<20,(95,3%,82.3%) for KDPI 30-34,(94.4%,80.4%) for KDPI 35-49 ,(92.7%,73.9%) for KDPI 50-79 and (88.2%,63.8%) for KDPI >80 respectively. Figure 1 shows renal allograft survival in deceased donor renal transplant recipients with donor serum creatinine >=2mg/dl stratified by kidney donor profile index (KDPI) categories.

*Conclusions: Long term renal allograft outcomes in deceased donor renal transplants with donor serum creatinine >=2 mg /dl were comparable to those with lower donor creatinine levels across different KDPI groups.

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