Does Severity of Donor Acute Kidney Injury Influence Outcomes Following Kidney Transplantation?

Abstract

The study purpose was to review retrospectively our single-center experience transplanting kidneys from deceased donors (DD) with acute kidney injury (AKI) according to terminal serum creatinine (tSCr) level. AKI kidneys were defined by a doubling of the DD's admission SCr and a tSCr ≥ 2.0mg/dL. From 1/07 to 11/21, we transplanted 236 AKI DD kidneys, including 100 with a tSCr ≥ 3.0mg/dL (high SCr AKI group, mean tSCr 4.2mg/dL), and the remaining 136 from DDs with a tSCr of 2.0-2.99mg/dL (lower SCr AKI group, mean tSCr 2.4mg/dL). These two AKI groups were compared to 996 concurrent control patients receiving DD kidneys with a tSCr < 1.0mg/dL. Mean follow-up was 69 months. Delayed graft function (DGF) rates were 51%versus 46%versus 29% (p < 0.0001), and 5-year patient and death-censored kidney graft survival rates were 96.8%versus 83.5%versus 82.2% (p=0.002) and 86.7%versus 77.8%versus 78.8% (p=0.18) in the high tSCr AKI versus lower tSCr AKI versus control groups, respectively. Despite a higher incidence of DGF, patients receiving kidneys from DDs with tSCr levels ≥3.0mg/dL have acceptable medium-term outcomes compared to either AKI DDs with a lower tSCr or DDs with a tSCr < 1.0mg/dL.