title: Evolving experience using kidneys from deceased donors with terminal acute kidney injury.
abstract: BACKGROUND
  Kidney transplantation from deceased donors with terminal acute kidney injury (AKI) is not widely accepted.
  
  
  METHODS
  Acute kidney injury donor kidneys were defined by a doubling of the donor's admission serum creatinine (SCr) level and a terminal SCr level >2.0 mg/dL before organ recovery.
  
  
  RESULTS
  Over 5.5 years, we transplanted 84 AKI donor kidneys, including 64 kidneys from standard criteria donors (SCD), 11 from expanded criteria donors (ECD), and 9 from donation after cardiac death (DCD) donors. Mean donor age was 36 years (range 15 to 68 years); mean admission and terminal donor SCr levels were 1.25 mg/dL and 3.2 mg/dL, respectively (mean terminal estimated glomerular filtration rate 25.5 mL/minute). With a mean follow-up of 35 months (range 6 to 70 months), actual patient and graft survival rates are 98% and 89%, respectively, which are numerically, but not statistically, higher than concurrent kidney transplants from brain-dead (non-AKI) SCDs at our center. Delayed graft function (DGF) occurred in 34 patients (40%). Mean 1-, 12-, and 24-month SCr levels were 1.8, 1.6, and 1.7 mg/dL, respectively. Delayed graft function was associated with lower 3-year graft survival for non-AKI SCD transplants (68% vs 90%, with and without DGF), but there was no impact of DGF on graft survival for AKI donor kidneys (89% vs 91%).
  
  
  CONCLUSIONS
  Although AKI donor kidneys more commonly have DGF, the higher rate of DGF does not worsen graft outcomes. Kidneys from deceased donors with terminal AKI transplanted into appropriately selected patients have excellent medium-term outcomes and represent a method to safely expand the donor pool.
authors: Department of General Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA. afarney@wakehealth.edu
authors: Alan C
authors: AC
authors: Farney
authors: Jeffrey
authors: J
authors: Rogers
authors: Giuseppe
authors: G
authors: Orlando
authors: Samer
authors: S
authors: al-Geizawi
authors: Michael
authors: M
authors: Buckley
authors: Umar
authors: U
authors: Farooq
authors: Yousef
authors: Y
authors: al-Shraideh
authors: Robert J
authors: RJ
authors: Stratta
mesh_terms: D058186:Acute Kidney Injury; D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D055815:Young Adult