Due to the shortage of kidneys available for transplantation and the morbidity and mortality that occurs while patients wait for a transplant, utilization of organs from deceased donors with acute kidney injury (AKI) may provide an important source of organs that might otherwise be discarded.

Methods: We reviewed 688 deceased donor kidney transplants performed at our center from 11/2001 through 12/2010. Transplants from DCD donors were excluded. A terminal creatinine (tCr) of 2.0 or higher in the donor was chosen as a surrogate marker for AKI. Donors were broken down into 4 groups: (1) ECD with tCr < 2.0 mg/dL, (2) ECD with tCr ≥ 2.0, (3) SCD with tCr < 2.0 and (4) SCD with tCr ≥ 2.0. Recipient demographics, donor and transplant characteristics, and post-transplant outcomes (DGF (defined as need for dialysis within 7 days of transplant); death-censored graft survival) were compared between groups.

Results: Patient demographics were similar between groups; ECD recipients were older. All patients received induction therapy (rabbit ATG or basiliximab) and tacrolimus/MPA ± steroids. Donor, transplant and recipient characteristics that relate to organ function are seen in Table 1.

As seen below in Figure 1, death-censored graft survival was similar between groups (P=0.22); three-year graft survival was 83.3%, 79.0%, 88.6%, and 87.4% in groups 1 through 4, respectively.

Conclusion: Utilization of kidneys from deceased donors with AKI is associated with a higher risk of DGF, however, death-censored graft survival is similar to kidneys without AKI.

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