Kidney transplant candidates who accept a kidney from a donor with acute kidney injury (AKI) experience improved survival compared with those who decline such a kidney, according to data presented at the American Transplant Congress 2020 virtual scientific program.

Using 2010-2018 data from the Scientific Registry of Transplant Recipients, Yifan Yu, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues identified 124,690 adult transplant candidates who were offered an AKI kidney. Of these, 120,932 declined the first offer of an AKI kidney. The 5-year survival rate was significantly higher among acceptors than decliners (88.6% vs 76.6%). Candidates who accepted an AKI kidney had a 48% decreased risk of death in adjusted analyses compared with those who did not.

Within 8 years of declining an AKI kidney, 35.2% of candidates received a non-AKI kidney, 5% received an AKI kidney, 35% were removed from the transplant waiting list for other reasons, 3.8% remained on the waiting list, 7.5% received a living donor kidney transplant, and 13% had died.

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“Accepting an AKI was associated with improved long-term survival,” the investigators concluded in their study abstract. “Patients and clinicians should consider benefits of accepting and consequences of declining an AKI kidney when considering offers.”


Yu Y, Long J, Bowring M, et al. Survival benefit of accepting kidneys with acute kidney injury [abstract] Am J Transplant. 2020;20 (suppl 3).