The absolute number of stage 3 acute kidney injury (AKI) kidney transplants increased from 2010 to 2020, a new study finds, but these organs continue to be underutilized.

In a retrospective analysis of US registry data, 172,410 kidneys were procured from 93,341 deceased donors aged 16 years or older from 2010 to 2020. Of these, 34,984 kidneys were discarded, including 17,559 kidneys with AKI.

Donors with stage 3 AKI increased from 6% in 2010 to 12% in 2020, Chirag R. Parikh, MBBS, PhD, of Johns Hopkins University in Baltimore, Maryland, and colleagues reported in the American Journal of Transplantation. Procurement of stage 3 AKI kidneys increased from 51% to 80%. Discard of stage 3 AKI kidneys, however, nominally increased from 41% in 2010 to 44% in 2020.

Continue Reading

“Ongoing high discard rates of these kidneys suggest opportunities for improved utilization,” according to Dr Parikh’s team.

The investigators deliberately chose the lowest serum creatinine on admission as the baseline to calculate AKI in deceased donors. The Kidney Donor Profile Index (KDPI) calculation uses the terminal serum creatinine measurement at the time of organ procurement — a practice that “fails to distinguish between transient serum creatinine increases in deceased donors with AKI from those with preexisting chronic kidney disease.”

The majority of transplant centers used few stage 3 AKI kidneys, and almost half of all US transplant centers did not use any stage 3 AKI kidneys in 2020, the investigators reported. The proportion of transplant centers that used stage 3 AKI kidneys increased from 36% in 2010 to 56% in 2020. High utilization of stage 3 AKI kidneys (defined as more than 5% of transplants at the center that year) increased from 13% in 2010 to 32% in 2020.

A small proportion of transplant centers appear to have aggressively utilized these kidneys, Dr Parikh’s team noted. They acknowledged that the COVID-19 pandemic influenced organ transplantation rates in 2020.

Despite the possibly higher KDPI of AKI kidneys, results from observational studies support their use. A recent study published in JAMA Network Open, for example, found comparable graft survival after transplantation of deceased-donor AKI kidneys.

There is “continued room for improvement” in utilization of stage 3 AKI kidneys, the investigators concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Liu C, Alasfar S, Reese PP, et al. Trends in the procurement and discard of kidneys from deceased donors with acute kidney injury. Am J Transplant. Published online December 12, 2021. doi:10.1111/ajt.16920