To investigate the effects of donor kidneys with acute kidney injury (AKI) on the prognosis of kidney transplant recipients and transplanted kidneys .

A total of 71 donors with AKI before kidney donation (AKI stages 1, 2 and 3 were 31, 16 and 18 cases, respectively) and 78 donors without AKI were selected from the Organ Transplantation Department of the Renmin Hospital of Wuhan University from January 2015 to September 2021. There were 136 recipients in the AKI group (70, 32, and 34 recipients in AKI stages 1, 2, and 3), and 154 recipients in the non-AKI group. Group t test or One-Way ANOVA were used to compare the normal distribution measurement data. Chi-square test or Fisher′s exact probability methods were used to compare the count data. Kaplan-Meier method was used to plot the recipient/graft survival curve and log-rank test was used for comparison. P<0.05 was considered statistically significant.

In the AKI group, the serum creatinine at admission, and serum creatinine, urea nitrogen, hemoglobin, and the percentage of positive urine protein at donor kidney acquisition were (91±51) μmol/L, (206±126) μmol/L, (17±16) mmol/L, (121±28) g/L and 53.5% (38/71), respectively; and those were (66±33) μmol/L, (53±24) μmol/L, (9±4) mmol/L, (108±22) g/L and 21.8% (17/78) in Non-AKI group, the differences were statistically significant (t=-3.488, -10.096, -0.432 and -3.066, χ²=16.065, all P<0.05). There were significant differences in serum creatinine at admission, and serum creatinine and albumin at donor kidney acquisition among donors with AKI stage 1, AKI stage 2 and AKI stage 3 (F=8.275, 15.012 and 3.84, all P<0.05). In the non-AKI group, serum creatinine at 1 month after surgery, the percentage of delayed graft function, transplanted kidneys survival rate were (106±47) μmol/L, 9.1% (14/154) and 98.1% (151/158), respectively; and those were (126±82) μmol/L, 25.0% (34/136) and 86.8% (118/136) in AKI group, and the differences were statistically significant (t=-2.561, χ²=13.234 and 9.445, all P<0.05). There was significant difference in the survival rate of corresponding transplanted kidneys for the AKI group and the non-AKI group (χ²=9.445, P<0.05). There was no statistically significant difference in the survival rate of corresponding recipients for the AKI group and the non-AKI group (χ²=3.107, P>0.05). There was no significant difference in the survival rate of corresponding transplanted kidneys and recipients for donors with different AKI stages (χ²=1.643 and 1.257, all P>0.05).

After active organ maintenance, donor kidneys from high-stage AKI donors can achieve transplantation effects similar to those from low-stage AKI donors. Donor kidneys from high-stage AKI donors can be used as a way to expand donor kidney sources after professional evaluation and screening.