*Purpose: The use of kidneys with high terminal creatinine has been demonstrated in renal transplantation with excellent outcomes. Here we explore the use of high terminal creatinine donors for simultaneous pancreas-kidney recipients.

*Methods: A retrospective, single center study of 54 simultaneous pancreas-kidney (SPK) recipients who received a kidney from a non-AKI donor (n=32) compared to donors with acute kidney injury (AKI) (n=22). AKI was defined as a terminal creatinine level 1.5x greater than the initial admitting creatinine. Post-operative outcomes included length of Stay (LOS), delayed graft function (DGF), glomerular filtration rate (GFR), Hemoglobin A1c (HbA1c).

*Results: There was no difference in recipient age (39.2 vs 39.4 years, p=0.95) or sex (53 vs 68% male, p=0.27) in the non-AKI and AKI groups. There was no significant difference in donor age (22.7 vs. 23.8 years, p=0.55). During a median 716 days [range: 109-1982] there was one patient death in the non-AKI group. There was no difference in LOS between the non-AKI and AKI groups (9.8 vs. 11.6 days, p=0.46). However, significantly lower rate of DGF occurred in the non-AKI group (9.4 vs. 40.9%, p=0.01). Graft function between two groups was comparable at 1-month (59.3 ml/min vs. 51.3 ml/min; p=0.20), 3-months (62.7 ml/min vs. 69.3 ml/min; p=0.23), 6-months (62.6 ml/min vs. 65.6 ml/min; p=0.56) and 12-months postoperatively (60.0 ml/min vs. 62.8 ml/min; p=0.70). HbA1c was not statistically significant in the non-AKI group compared to AKI group at 3-months (5.3% vs 5.3%; p=0.78), 6-months (5.3% vs. 5.3%, p=0.89) and 12-months (5.6% vs. 5.4%; p=0.43). There was one death in the non-AKI group.

*Conclusions: Kidneys from AKI donors with high terminal creatinine demonstrated comparable outcomes to non-AKI donors.

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