DCD Renal Transplantation from donors with Acute Kidney Injury.

BACKGROUND: Deceased donor kidneys with acute kidney injury (AKI) and deceased after circulatory death kidneys are viable sources of organs. The outcomes of renal transplantation from deceased after circulatory death (DCD) donors with AKI are not known. METHODS: A retrospective review of deceased donor renal transplants performed from 2006-2016 was conducted using the UNOS dataset. Donors were stratified by DCD or brain dead (BD) status and by AKI stage. Recipients were followed until graft failure, or the end of study. Cox regression was used to adjust for donor, recipient and transplant covariates known to affect the incidence of delayed graft function (DGF) and graft survival. RESULTS: 135,644 patients were included in the study. The odds of DGF amongst DCD recipients were significantly higher across all donor AKI stages. The unadjusted risk of overall and death censored graft failure were similar between the two groups. After adjusting for covariates, there was a significant increase in the risk of overall graft failure in recipients of DCD allografts from donors with Stage 2 Acute Kidney injury. There was also a higher risk of death-censored graft failure amongst Stage 1 and 2 AKI DCD recipients. CONCLUSIONS: DCD renal allografts from donors experiencing Stage 1 and 2 AKI have a higher adjusted risk of death-censored graft failure than AKI stage-matched DBD renal allografts. Their use however is still associated with improved outcomes compared to waitlist mortality.