Impact of donor’s acute kidney injury on graft outcomes of deceased donor kidney transplantation

Deceased donor kidney transplantation (DDKT) has a serious problem of donor organ shortage, particularly in Asia. Consequently, donor kidneys with acute kidney injury (AKI) have been utilized for transplantation. This study aimed to evaluate the prognosis of DDKT using AKI kidneys. We analyzed the data of 8,523 adult patients who underwent DDKT between 2008 and 2022 using the Korean nationwide DDKT database. The association between donor AKI and death-censored graft failure was assessed using competing risk analysis, with adjustment through inverse probability of treatment weighting (IPTW). The AKI group included 3,453 patients (40.51%) and had a higher death-censored graft failure risk than the no-AKI group (hazard ratio: 1.27; 95% confidence interval: 1.05-1.53). Especially, AKI stage 3 subgroup had a higher death-censored graft failure risk than the no-AKI group. Furthermore, the AKI group had a higher death-censored graft failure risk than the no-AKI group in the subgroup with a Korean-kidney donor profile index (K-KDPI) ≥ 70 or the stable- or increasing trend of serum creatinine. In conclusion, using AKI kidneys with a K-KDPI < 70% or a decreasing creatinine trend, or at stage 1 and 2, could help in combating organ shortage, especially in areas with a long waiting time.