Abstract
Donor rhabdomyolysis may constrain kidney utilization due to anticipated unfavorable graft outcomes-especially in combination with acute kidney injury (AKI). There is a paucity of empiric data to inform organ acceptance decision-making. A single-center retrospective cohort study of adult transplant recipients of deceased-donor kidneys with reported donor creatine phosphokinase (CPK) levels was conducted between 2014 and 2020. Recipients of CPK ≥ 1000U/L kidneys were propensity matched to CPK<1000 recipients according to outcome-predictive baseline covariates, except AKI. A total of 254 kidney transplants were propensity matched into CPK ≥ 1000 (n=90) versus CPK<1000 (n=90) groups. Transplant outcomes with high versus low CPK kidneys were similar in terms of delayed graft function (P=0.64), 1-year estimated glomerular filtration rate<25th percentile (P=0.69) and mean (P=0.58), and time to all-cause graft failure (P=0.58). There was no interaction between AKI and high CPK for these outcomes. Extreme CPK thresholds as high as>8672U/L were not associated with overall graft survival in the unmatched sample (P=0.81). In a single center study, donor rhabdomyolysis was not associated with short-term kidney transplant graft outcomes, nor was there an additive effect of AKI. However, studies with greater CPK and AKI severity and longer follow-up are warranted.
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