Expanding the Utilization of Kidneys from Donors with Acute Kidney Injury

Purpose of Review Our aim is to review the experience with transplanting kidneys from decreased donors with acute kidney injury (AKI). Recent Findings The discard rate is higher for kidneys from AKI donors. Studies have uniformly shown that the risk of delayed graft function (DGF) is higher. However, the majority of studies have shown that other outcomes including short and long graft survival, eGFR, and risk of rejection are not inferior with transplanting AKI donor kidneys. To select AKI donor kidneys, we depend on preimplantation biopsy to exclude AKI kidneys with > 10% cortical necrosis or more than mild chronic changes. Although the DGF rate is higher, we have been able to safely discharge patients by POD 2 and manage DGF as an outpatient. Summary It is estimated that if the transplant community used appropriately selected kidneys from AKI donors, there would be almost 600 additional transplants done each year in the US.