Deceased-donor acute kidney injury is not associated with kidney allograft failure

Isaac E. Hall, Enver Akalin, Jonathan S. Bromberg, Mona D. Doshi, Tom Greene, Meera N. Harhay, Yaqi Jia, Sherry G. Mansour, Sumit Mohan, Thangamani Muthukumar, Peter P. Reese, Bernd Schröppel, Pooja Singh, Heather R. Thiessen-Philbrook, Francis L. Weng, Chirag R. Parikh

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


Deceased-donor acute kidney injury (AKI) is associated with organ discard and delayed graft function, but data on longer-term allograft survival are limited. We performed a multicenter study to determine associations between donor AKI (from none to severe based on AKI Network stages) and all-cause graft failure, adjusting for donor, transplant, and recipient factors. We examined whether any of the following factors modified the relationship between donor AKI and graft survival: kidney donor profile index, cold ischemia time, donation after cardiac death, expanded-criteria donation, kidney machine perfusion, donor-recipient gender combinations, or delayed graft function. We also evaluated the association between donor AKI and a 3-year composite outcome of all-cause graft failure or estimated glomerular filtration rate ≤ 20 mL/min/1.73 m 2 in a subcohort of 30% of recipients. Among 2,430 kidneys transplanted from 1,298 deceased donors, 585 (24%) were from donors with AKI. Over a median follow-up of 4.0 years, there were no significant differences in graft survival by donor AKI stage. We found no evidence that pre-specified variables modified the effect of donor AKI on graft survival. In the subcohort, donor AKI was not associated with the 3-year composite outcome. Donor AKI was not associated with graft failure in this well-phenotyped cohort. Given the organ shortage, the transplant community should consider measures to increase utilization of kidneys from deceased donors with AKI.

Original languageEnglish (US)
Pages (from-to)199-209
Number of pages11
JournalKidney international
Issue number1
StatePublished - Jan 2019


  • acute kidney injury
  • chronic allograft nephropathy
  • delayed graft function

ASJC Scopus subject areas

  • Nephrology


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