Purpose: Kidneys from deceased donors with elevated creatinine are frequently discarded due to concerns about poor post-transplant outcomes. In this study we sought to determine the characteristics and outcomes of kidneys transplanted from deceased donors with a terminal creatinine ≥ 3.0 mg/dL.

Methods: A retrospective review of all kidney transplants performed at a single institution between 1/1/04-12/31/13.

Results: 720 deceased donor kidney transplants were performed during the study period of which 634 donors had a tPcr < 3.0 mg/dL (Normal) and 86 had a tPcr ≥ 3.0 mg/dL (High). There was no difference between the Normal and High groups with regards to recipient age, years of dialysis, hypertension, diabetes, donor age, percentage of donation after cardiac death donors, and incidence of recipient delayed graft function. One- and three- year graft survival were 96.0% and 87.8% for the Normal group and 95.4% and 91.4% for the High group, p=0.29. One- and three- year patient survival were 98.0% and 93.4% for the Normal group and 96.5% and 94.0% for the High group, p=0.68. Within the High group, the mean initial recorded Pcr was 1.42 mg/dL with a mean tPcr of 4.3 mg/dL. Five kidneys were from anuric donors and one kidney was from a donor on hemodialysis. On multivariate analysis, increasing reciepient age and donor age was associated with decreased graft survival. Increased recipient age and diabetes as the cause of end-stage renal disease were associated with decreased patient survival.

Conclusions: When properly selected, kidneys from donors in acute renal failure with tPcr ≥ 3.0 mg/dL can have excellent outcomes comparable to those of kidneys with a tPcr < 3.0 mg/dL. Such kidneys should not be summarily discarded and represent a potential expansion of the donor pool. Traditional factors such as recipient age and diabetes continue to be the main determinants of post-transplant survival.

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