Introduction: Kidneys from donors with elevated terminal creatinine (Cr) and acute kidney injury (AKI) can be transplanted safely, yet many of these organs are not utilized. Wait-list, OPO and center practices all play a role in decision making. In an attempt to expand the donor pool, we examined characteristics of un-recovered kidneys to see if similar patterns exist.

Methods: Deceased donor kidneys available for transplant but not recovered from 2005-2015 were analyzed using the SRTR standard access file (2016 Quarter 1). Kidneys without both initial and terminal Cr were excluded and AKI was defined using delta Cr of at least 0.3 mg/dL. Net flow of an OPO was calculated by the difference between the number of imports and exports divided by kidneys recovered. OPOs were then classified on this basis as net-importers or exporters.

Results: Of 12570 kidneys un-recovered, 7950 (63%) had a terminal Cr>2. Within this group, 77% had AKI. Compared to donors without AKI these donors were marginally older but less likely to have unfavorable comorbidities or death due to stroke. They also had lower mean initial Cr and KDPI. Net exporting OPOs accounted for the majority of un-recovered kidneys, both with and without AKI.

Conclusions: A large percentage of un-recovered kidneys with elevated terminal Cr come from donors with AKI and were located in OPOs classified as net-exporters. We hypothesize this may reflect attitudes of less aggressive local centers. Since many of these kidneys have better function than their terminal Cr indicates recovery represents an easy way to expand our supply.

CITATION INFORMATION: Bongu A., Quillin R., Chiles M., Husain S., Garcia M., Mohan S., Ratner L. No Kidney Left Behind: Are We Maximizing Utilization of Deceased Donors with AKI? Am J Transplant. 2017;17 (suppl 3).

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