*Purpose: When assessing deceased donor kidneys, the transplantation team studies several donor variables including creatinine. A creatinine that is elevated immediately prior to procurement can sometimes be concerning and cause declination of kidney for transplant. We aim to assess outcomes based on terminal creatinine.

*Methods: Using the Scientific Registry of Transplant Recipients database we evaluated outcomes of transplantation based on terminal creatinine <1.5, 1.5-3.0 and >3.0. The outcomes studied were delayed graft function (DGF), primary non-function (PNF), 1 and 3 year graft survival.

*Results: A total of 98709 donors were stratified according to terminal creatinine values of <1.5, 1.5-3.0, >3.0, representing 80%, 15% and 5% of all donors respectively. Donors with terminal creatinine >3.0 were significantly younger compared to <1.5 and 1.5-3.0 groups (34.9 vs 37.6 vs 39.6; p<0.0001) and the <1.5 group were less likely to be male compared to the 1.5-3.0 and >3.0 groups (58% vs 72% vs 70%; p <0.0001) and more likely to be white (69% vs 61% vs 64% respectively; p<0.0001). Also the >3.0 group were significantly more likely to have died from anoxia compared to the <1.5 and 1.5-3.0 groups (65% vs 32% vs 41%). Overall DGF rate was significantly different between the <1.5, 1.5-3.0, and >3.0 groups with rates of 23% vs 34% vs 56% respectively (p<0.001), with multiple logistic regression analysis modelling showing an odds ratio of 4.09 in the >3.0 group. The >3.0 group actually had statistically significant superior 1 and 3 year graft survival rates and lower PNF than the other groups, though this accounted for minimal percentage differences and the 1 year and PNF rates were not significantly different after multivariate analysis.

*Conclusions: Despite limitations of not including recipient risk factors for DGF, PNF and graft survival and differentiating between brain and cardiac death donors, analysis of donor terminal creatinine suggests that only DGF is significantly more likely with terminal creatinine >3.0, with excellent 1 and 3 year graft survival and low PNF rates, in this group, suggesting that terminal creatinine should not weigh heavily in the decision to decline an organ.

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