Transplantation of Kidneys From Donors With Acute Kidney Injury: Friend or Foe?

The gap between supply and demand in kidney transplantation has led to increased use of marginal kidneys; however, kidneys with acute kidney injury are often declined/discarded. To determine whether this policy is justified, we analyzed outcomes of donor kidneys with acute kidney injury ( AKI ) in a large UK cohort. A retrospective analysis of the UK Transplant Registry evaluated deceased donors between 2003 and 2013. Donors were classified as no AKI , or AKI stage 1–3 according to Acute Kidney Injury Network ( AKIN ) criteria. Relationship of AKI with delayed graft function/primary nonfunction ( DGF / PNF ), estimated glomerular filtration rate ( eGFR ), and graft‐survival at 90 days and 1 year was analyzed. There were 11 219 kidneys (1869 [17%] with AKI ) included. Graft failure at 1 year is greater for donors with AKI than for those without (graft survival 89% vs. 91%, p = 0.02; odds ratio ( OR ) 1.20 [95% confidence interval ( CI ): 1.03–1.41]). DGF rates increase with donor AKI stage (p < 0.005), and PNF rates are significantly higher for AKIN stage 3 kidneys (9% vs. 4%, p = 0.04) Analysis of association between AKI and recipient eGFR suggests a risk of inferior eGFR with AKI versus no AKI (p < 0.005; OR 1.25 [95% CI : 1.08–1.31]). We report a small reduction in 1‐year graft‐survival of kidneys from donors with AKI . We conclude that AKI stage 1 or 2 kidneys should be used; however, caution is advised for AKI stage 3 donors.