*Purpose: Older patients are perceived to tolerate delayed graft function (DGF) poorly and there is a reluctance to transplant a kidney from an AKI donor into older recipients. Our aim was to examine the outcomes of older transplant recipients (age ≥65years) receiving kidneys from donors with AKI.

*Methods: We included all patients ≥65 years of age who received deceased donor kidney transplants from 2/1/08 – 12/29/19 at our center. We used acute kidney injury network (AKIN) criteria to assess the severity of AKI in the donors. Patients who received kidneys from donors with AKIN2-3 were compared to those receiving kidneys from AKIN0-1 donors. The primary outcomes were patient survival, all-cause and death-censored graft survival.

*Results: Of the 594 patients who received kidney transplant at our center during the study period 265 received AKIN 2-3 kidneys and 329 received AKIN 0-1 kidneys. Baseline characteristics were similar between the 2 groups. AKIN 2-3 had a lower KDPI (58 Vs 68), younger donor age (43 Vs 51) and lower % of DCD kidneys (12 VS 23%). DGF rate was higher in the AKIN 2-3 group (65% vs 45%). The patient survival, graft survival, death censored graft survival, 1 year GFR and rejection rate were not significantly different. Biopsies at 1 year showed no significant difference for acute or chronic changes (table 2). Death with functioning graft was the most common cause for graft failure in both groups (67.4% AKIN0-1 Vs 69.8% AKIN2-3). 4 cases of primary non function (PNF) were seen in AKIN0-1 Vs 3 in AKIN2-3.

*Conclusions: Despite higher rate of DGF, recipients ≥ 65 tolerate AKIN 2-3 kidneys well and have equivalent outcomes to those receiving AKIN 0-1 kidneys. As expected, death with functioning graft is the primary cause for graft loss in older recipients. Older recipients should not be excluded from receiving kidneys from severe AKI donors.

« Back to 2021 American Transplant Congress