Outcomes of kidney transplants from pediatric donors with acute kidney injury.

Pediatric deceased donor kidneys with acute kidney injury (ped-AKI) are at increased risk for nonutilization. To evaluate the posttransplant outcomes of ped-AKI recipients, we conducted a retrospective cohort study, comparing 17,731 adult recipients of kidneys from pediatric donors without AKI (ped-non-AKI, terminal serum creatinine <1 mg/dL) to 1589 ped-AKI recipients (serum creatinine ≥2 mg/dL). We used weighted logistic regression to estimate the association between ped-AKI and delayed graft function (DGF), and weighted Cox regression to estimate the association between ped-AKI and primary nonfunction (PNF) and all-cause graft failure (ACGF). Ped-AKI kidney recipients were at 6.0-fold (aOR = 5.325.986.72), 1.9-fold (aHR = 1.361.872.58), and 1.4-fold (aHR = 1.161.431.76) higher risk of DGF, PNF, and 1-year ACGF compared with ped-non-AKI recipients. En bloc ped-AKI recipients were at 5.6-fold (aOR = 3.295.579.43), 3.3-fold (aHR = 1.723.256.15), and 2.9-fold (aHR = 1.702.925.01) higher risk of DGF, PNF, 1-year ACGF compared with to en bloc ped-non-AKI recipients. Among recipients of single kidneys from donors <20 kg, ped-AKI recipients were at 8.9-fold (aOR = 4.348.8718.12), 5-fold (aHR = 1.694.9914.75), and 3.4-fold (aHR = 1.473.448.05) higher risk of DGF, PNF, 1-year ACGF compared with ped-non-AKI recipients. Ped-AKI kidney recipients have higher risks of early graft complications and failure. Risks are greatest for recipients of single kidneys from donors <20 kg. Careful recipient selection and counseling are prudent when considering ped-AKI kidney offers.