There is justified reluctance to use kidneys from donors with significantly elevated creatinine as they may have severe, irreversible injury. Recently, thanks, in part to the COIN project, some limits of deceased donor acceptability are being pushed. We have had success in using selected kidneys with significantly elevated creatinine. Therefore, we are examining the national results using the UNOS/OPTN database. To assess current outcomes, we chose to examine outcomes from the past decade (6/2007 through 6/2017 (n = 91,234). Re-transplants, dual or en block, and multi-organ transplant kidneys were excluded. Log rank and Wilcoxon tests, which favors the early differences in survival, were used. Overall, there was no statistically significant difference in graft survival with increased donor Creatinine. Cox univariate analysis demonstrated that terminal Cr as a continuous variable or stratified in bins of 2 mg/dl Cr was not an import risk factor for graft survival. This result was maintained when the data were stratified by donor age, recipient age and gender, donor age and gender, pediatric or adult recipient, DCD, or KDPI. Conclusion: This large database study suggests that kidneys from donors with a significantly elevated terminal creatinine have graft survival similar to those with a terminal creatinine within the normal range.

CITATION INFORMATION: Rayhill S., Haldorson J. Elevated Donor Terminal Creatinine Does Not Appear to Be Associated with Worse Outcomes in Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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