*Purpose: Accepting an acute kidney injury kidney (AKI) or remaining on the waitlist to receive a better offer is under discussed due to the worse outcome of transplant from an AKI kidney. This study characterized the survival benefit associated with accepting AKI kidneys to better inform on clinical decision making and counseling.

*Methods: Using SRTR data 2010-2018, we identified 124,690 adult transplant candidates who were offered an AKI kidney. Multivariable Cox regression was used to compare mortality risk between matched groups. We estimated candidates weighted survival by Kaplan-Meier method. To understand consequences of declining an AKI kidney offer, we followed 120,932 candidates who declined the first AKI offer until defined outcomes.

*Results: Candidates who accepted an AKI kidney had a 48% lower risk of death compared to those who declined (HR = 0.460.520.58, p<0.001). Although in the first 30 days following the offer, candidates who accepted the AKI offer had worse survival than those who declined (99.43% vs. 99.78%), they had a better survival within 1 year (97.17% vs. 96.35%), 2 years (95.47% vs. 91.78%), 5 years (88.56% vs. 76.65%) post-decision compared to those who declined (Figure, left panel). Within eight years after declining an AKI kidney, 35.2% of candidates received a non-AKI kidney, 5% received an AKI kidney, 13% of candidates had died, 35.5% were removed from the waitlist for other reasons, 7.5% received an LDKT, and 3.8% remained on the waitlist (Figure, right panel).

*Conclusions: Accepting an AKI kidney was associated with improved long-term survival. Patients and clinicians should consider benefits of accepting and consequences of declining an AKI kidney when considering offers.

« Back to 2020 American Transplant Congress