Single-Center Short-Term Outcomes in Recipients of Deceased Donor Kidneys with AKI

Background: Previous reports suggest that long term outcomes in recipients of deceased donor kidneys (DDKT) from donors with acute kidney injury (AKI) are comparable to those without AKI. We report short term outcomes in 20 recipients of AKI donor kidneys compared to 20 recipients of kidneys without AKI to provide insight into optimal deceased donor acceptance criteria. Methods: We reviewed data on 40 consecutive recipients of DDKT done at the Baystate Transplant Program between October 2023 and March of 2024. Twenty of these were from donors with AKI defined as terminal creatinine (Cr)> 1.5 times admission Cr. We used UNET data to collect demographics, KDPI, DCD criteria, terminal creatinine and urine output, and pre-implantation biopsy findings. Cold ischemia time (CIT) was obtained from the OPO. Recipient outcomes were evaluated as part of quality review. Results: The mean age and KDPI of recipients of AKI vs. standard kidneys was 58.2 vs.59.7 years and 70.15 (43-98) vs. 76.2 (49-98), respectively. AKI kidney donor age was higher, 61.8 vs. 51.1 years, with a similar number of DCD donors in each group ( 9 vs. 10). CIT was higher in the AKI donor group: 1436 vs. 1215 min. LOS was comparable between groups: 8 vs. 8.5 days ( excluding 1 recipient of an AKI kidney who remains hospitalized). More than twice as many recipients of AKI kidneys had DGF (13/20) vs. nonAKI (6/20). Mean Cr at 3 months for recipients of AKI vs. nonAKI kidneys were 2.42 and 2.26 mg/dl,respectively, and 45% vs. 44% had Cr>2 mg/dl at 3 months. Two recipients of AKI donors remained dialysis-dependent at 3 months post-transplant. These patients had significant post-transplant complications. For-cause allograft biopsies in 2/8 AKI recipients and 4/12 recipients of nonAKI donors revealed acute rejection. At 4 months post-transplant, 4 recipients of AKI donor kidneys vs none from nonAKI donors have been referred for retransplantation due to poor allograft function. Conclusion: Our single-center, short-term outcomes in 40 DDKT recipients are concordant with prior reports that kidneys from donors with AKI have similar allograft functional outcomes with no increase in rejection rate. Accepting kidneys from deceased donors with AKI can increase rates of transplantation but at the cost of more DGF and graft failures. Funding: Clinical Revenue Support