# Impact of deceased donor acute kidney injury (AKI) on renal transplant outcomes

## TL;DR

This study finds that kidneys from donors with acute kidney injury can still lead to good transplant outcomes, except for a higher risk of delayed graft function.

## Contribution

The study provides evidence that donor acute kidney injury should not automatically disqualify kidneys for transplantation.

## Key findings

- Donor AKI does not significantly affect 1-year or 5-year graft survival.
- There is no significant difference in post-transplant serum creatinine levels between donor AKI and non-AKI groups.
- Delayed graft function is more common in recipients of donor kidneys with AKI.

## Abstract

Donor AKI is a common reason for discarding deceased donor kidneys due to uncertainty regarding transplant outcomes. Our study investigated the effect of AKI in donor kidneys on post-transplantation outcomes.

Medline, Embase, Cochrane and Web of Science were searched. Risk of bias assessment was performed. 2984 studies were identified by the search, 34 met the inclusion criteria. A total of 103,529 kidney transplants were analysed, 97,165 (94 %) with and 6364 (6 %) without donor AKI.

There was no significant difference between recipients of grafts from donors with terminal serum creatinine >2.0 mg/dl and < 2.0 mg/dl in 1 year serum creatinine (MD: -0.01, CI: −0.09-0.07, P = 0.84), 1 year patient survival (RR: 0.99, CI: 0.96–1.02, P = 0.52), as well as in 1 year (RR: 1.01, CI: 0.98–1.03, P = 0.61) and 5 year (RR: 0.99, CI: 0.94–1.04, P = 0.63) graft survival. DGF was the only parameter significantly worse in recipients of grafts from donors with terminal serum creatinine >2.0 than to non-AKI recipients (RR: 1.89, CI: 1.64–2.17, P < 0.01). In studies that compared the severity of AKI stage using the AKIN criteria, there was no significant difference in 1 year post-transplantation serum creatinine even between recipients of grafts from the most severe AKI stage (AKIN3) and the non-AKI group (AKIN0) (MD: -0.01, CI:-0.17–0.16, P = 0.92).

Donor AKI is associated with a higher incidence of DGF but has no effect on post-transplant patient and graft survival and, based on this analysis, should not be a sole reason for discarding kidneys.

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