*Purpose: Kidneys with increased donor terminal creatinine are frequently discarded. This study used national data to assess renal allograft and patient outcomes in deceased donor renal transplants stratified by severity of donor acute kidney injury (AKI).

*Methods: All adult primary solitary kidney deceased donor transplants performed between 2008 and 2018 reported to the UNOS/OPTN database were analyzed. Groups were further stratified based on terminal donor serum creatinine into 4 groups. Group 1: Serum creatinine<1.5 mg /dl, group 2: 1.5- 1.9 mg/dl, group 3: 2-3.9 mg/dl and group 4 :>= 4 mg/dl .Renal allograft survival and patient survival rates were computed according to Kaplan-Meier and Cox proportional hazards were used to estimate the impact of potential influential variables.

*Results: In this cohort, the number of kidneys transplanted with terminal donor serum creatinine <1.5 mg/dl were 66,589 (78.6%),creatinine 1.5-1.9 mg /dl were 8513(10%),creatinine 2-3.9 mg/dl were 7308 (8.6%) and creatinine 4 mg/dl or greater were 2250(2.6%) respectively.Kidneys transplanted with higher donor serum creatinine increased over time as shown in Table 1. Rates of delayed graft function in the 4 groups were 24.6%, 31.3%, 41.7% and 62.7% respectively. One, three- and five-year renal allograft survival were comparable in the four groups, (93.5%. 85.3%, 75.4%) for donor terminal creatinine < 1.5 mg /dl, (92.3%,84.1%, 73.6%) for donor creatinine 1.5-1.9 mg/dl group, (93.1%,85.8%,75.4%) for donor creatinine 2-3.9 mg/dl and (94.0%, 87.5% ,79.3%) for donor creatinine >4 mg /dl. Patient survival was comparable in all AKI groups as well.

*Conclusions: Use of kidneys from donors with AKI does not adversely affect long term post-transplant outcomes. Careful selection and use of these kidneys will reduce discard rate and optimize organ utilization.

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