*Purpose: Kidneys from deceased donors with acute kidney injury (AKI) are discarded at a higher rate than those without AKI, exacerbating the organ shortage crisis. Thus, waitlist times that contribute to the attendant morbidity and mortality on dialysis are extended. With the belief that prolonged dialysis is one of the biggest modifiable risk factors for potential transplant recipients, our mission has been to increase the use of kidneys historically discarded, including AKI kidneys. This paper aims to present outcomes in AKI kidneys over a 30 month period.

*Methods: We retrospectively analyzed 694 consecutive deceased donor kidney recipients transplanted between 10/2016 and 03/2019 at our center. Donors were classified based on AKIN criteria for AKI based on increase of terminal serum creatinine (SCr) over initial SCr (stage 1 increased SCr X1.5-2 or ≥ 0.3mg/dL, stage 2 increased SCr X2-3, stage 3 increased cr X3), although it should be noted that the use of hemodialysis prior to procurement was unable to be determined which might have led to stage underestimation for some donors. Death-censored graft survival and eGFR (MDRD) were compared in recipients.

*Results: Using a Cox Proportional Hazards Model, graft survival at 1 year was not distinguishable between recipients whose donor had any stage of AKI versus donors without AKI (p=0.439, CI=95%) (Figure 1). Mean eGFR at 1 year was 59.813 ± 21.571 in recipients with non-AKI donors and 57.093 ± 24.714 in recipients with AKI donors, which is not statistically significant (p=0.1048, CI=95%) (Figure 2). Degree of AKI did not impact graft survival or 1 year eGFR amongst recipients. The rate of delayed graft function was expectedly significantly higher in recipients from AKI donors (48.6% stage I, 61.22% stage II, 64.49% stage III) versus non-AKI donors (24.59%). The presence of AKI at any level was not a significant risk factor of graft failure or reduced eGFR irrespective of donor characteristics.

*Conclusions: Recipients of AKI donors did not yield inferior outcomes to those of non-AKI donors at 1 year. Increased DGF can be anticipated, but does not appear to have any lasting impact. As such, transplant centers should consider expanding the use of these kidneys for any waitlisted candidate.

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