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

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 6,364 (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.