Impact of deceased donor acute kidney injury (AKI) on renal transplant outcomes
File(s)
Author(s)
Type
Journal Article
Abstract
Aims
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.
Methods
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.
Results
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).
Conclusions
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.
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.
Methods
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.
Results
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).
Conclusions
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.
Date Issued
2026-01-01
Date Acceptance
2025-11-05
Citation
Surgery Open Science, 2026, 29, pp.7-21
ISSN
2589-8450
Publisher
Elsevier
Start Page
7
End Page
21
Journal / Book Title
Surgery Open Science
Volume
29
Copyright Statement
© 2025 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41502817
PII: S2589-8450(25)00096-X
Subjects
BIOMARKERS
BRAIN-DEATH
CARDIAC DEATH
CLINICAL-OUTCOMES
CREATININE
DELAYED GRAFT FUNCTION
DIALYSIS
Life Sciences & Biomedicine
Science & Technology
Surgery
SURVIVAL
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2025-11-24