*Purpose: Long term outcomes of kidney transplantation from deceased donors with terminal acute kidney injury (AKI) are not well defined.

*Methods: Single center retrospective review of all deceased donor kidney transplants from 1/31/07-9/1/19. AKI donor kidneys were defined by a doubling of the donor’s admission serum creatinine (SCr) level and a terminal SCr > 2.0 mg/dl before organ recovery.

*Results: 185 AKI donor kidneys were transplanted during the study period, including 147 kidneys from standard criteria donors (SCD), 26 from expanded criteria donors (ECD), and 12 from donation after cardiac death (DCD). Mean donor age was 36 years (range 1 – 69 years); mean admission and terminal SCr levels were 1.3 mg/dl and 3.1 mg/dl, respectively (mean terminal eGFR 32 ml/min). With a mean follow-up of 78 months, actuarial graft survival was comparable to concurrent kidney transplants from brain-dead non-AKI SCD’s at our center (Table 1). Patient survival was similar between groups. Delayed graft function (DGF) occurred in 87 patients (47%) vs. 22% in recipients of non-AKI SCD kidneys (p < 0.001). Mean SCr at 48 months was 1.61. DGF was associated with lower graft survival in recipients of both AKI (Table 2) and non-AKI (Table 3) SCD kidneys but the impact was earlier and more pronounced in non-AKI recipients.

*Conclusions: Despite having a significantly higher incidence of DGF, kidneys from deceased donors with terminal AKI have long term outcomes that are comparable to non-AKI SCD kidneys and represent a safe and effective method to expand the donor pool.

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