Donor Acute Kidney Injury and Short- and Long-Term Graft Outcomes After Deceased Donor Kidney Transplantation: A...

Deceased donor kidney transplantation (DKT) remains an important treatment for end-stage kidney disease, but increasing reliance on marginal donors, including those with acute kidney injury (AKI), has raised concern regarding post-transplant outcomes. We evaluated the association between donor AKI and adverse long-term graft outcomes after DKT.

This retrospective single-center cohort study included 143 deceased donor kidney transplant recipients who underwent DKT between June 1, 2014 and December 31, 2023, with follow-up through December 31, 2024. Donor and recipient demographic and clinical variables were extracted from institutional records. The study outcomes, graft failure and graft rejection, were assessed in relation to donor AKI, donor and recipient clinical characteristics, and donor category.

Among 143 recipients, 93 (65.0%) received kidneys from donors with AKI. Graft failure occurred in 16.1% of recipients in the donor AKI group versus 10.0% in the non-AKI group (OR 1.73, 95% CI 0.59-5.08; P = .449). Median time to graft loss was shorter in the donor AKI group (2.18 vs 7.44 years; P = .101). Graft rejection occurred in 23.7% vs 30.0% of recipients, respectively (OR 0.72, 95% CI 0.33-1.56; P = .429). Rejection episodes clustered earlier in the donor AKI group, and serum creatinine was significantly higher at 6 months (P = .031), but not at later follow-up. Donor category, delayed graft function subgrouping, and recipient baseline clinical factors, including age, sex, body mass index, diabetes, and hypertension, were not significantly associated with graft outcomes.

Donor AKI was associated with numerically less favorable graft outcomes, earlier graft loss, and higher 6-month serum creatinine after DKT, although these associations did not reach statistical significance for graft failure or rejection. These findings provide exploratory clinical insight and support close post-transplant surveillance of recipients of kidneys from donors with AKI. Larger multicenter studies are needed to validate these observations.