Graft survival is no worse for deceased donor kidneys with acute kidney injury (DD-AKI) than without AKI, so DD-AKI kidneys should be actively harvested and transplanted, investigators reported online in JAMA Network Open.

Chirag R. Parikh, MD, PhD, of Johns Hopkins University in Baltimore, and colleagues matched 6722 DD-AKI kidneys with 6722 deceased donor kidneys without AKI and looked at graft outcomes in 25,323 recipients of those kidneys. Recipients had a median follow-up time of 5 years. DD-AKI status was not associated with either death-censored or all-cause graft failure. Significantly more recipients of AKI kidneys experienced delayed graft function, however: 29% vs 22%. Just 0.5% overall had primary nonfunction of the graft, but this did not relate to AKI.

Among the 58 organ procurement organizations (OPOs), 39 had high recovery and high discard of AKI kidneys, investigators reported. Just 13 OPOs had high recovery and low discard of AKI kidneys. The current national discard rate of DD-AKI kidneys is approximately 30%, which is higher than the 18% rejection rate for all potential donor kidneys, the authors noted.

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“We estimate there may hundreds of kidneys with AKI each year that are going unused but could be transplanted,” Dr Parikh stated in a Johns Hopkins news release. “Therefore, we are urging the transplant community to bring AKI kidneys into the donor pool with more confidence.”

Of 13,444 deceased donors, 8529 (63%) were male. Of the 25,323 recipients, 15,485 (61%) were male. The mean ages of donors and recipients were 40.4 and 50 years, respectively. The investigators matched deceased donors with and without AKI by age, sex, race, body mass index, and other characteristics.

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Liu C, Hall IE, Mansour S, Thiessen Philbrook HR, Jia Y, Parikh CR. Association of deceased donor acute kidney injury with recipient graft survival. JAMA Network Open. 2020;3(1):e1918634. doi: 10.1001/jamanetworkopen.2019.18634

Less-than-perfect kidneys can be successfully used for transplants, study shows [news release]. Johns Hopkins Medicine; January 8, 2020.