Outcomes of Kidney Transplants from Donors after Circulatory Death with Acute Kidney Injury: A Systematic Review

Background: Kidney transplantation offers superior survival to dialysis, but donor organ shortage limits access. Utilizing kidneys from donation after circulatory death (DCD) donors with acute kidney injury (AKI) could expand the donor pool, but concerns about outcomes persist. This systematic review aimed to evaluate the outcomes of kidney transplantation from DCD donors with AKI. Methods: A systematic literature search was conducted in PubMed, Embase, and Cochrane Library up to September 25, 2024. Studies reporting kidney transplantation outcomes in recipients of DCD donors with AKI were included. Meta-analysis was planned but limited by the number and weighting of included studies. Delayed graft function (DGF), primary nonfunction (PNF), estimated glomerular filtration rate (eGFR), and graft survival were assessed. Results: Seven studies (5731 patients) were included. Meta-analysis showed a significantly higher risk of DGF in DCD kidney transplants with donor AKI. PNF rates were similar. One-year eGFR and graft survival were comparable between recipients of kidneys from DCD donors with and without AKI. Conclusion: While DCD kidney transplants with donor AKI are associated with an increased risk of DGF, long-term graft survival appears comparable to those without AKI. These findings suggest that utilizing such kidneys can be a viable strategy to expand the donor pool, although careful consideration of DGF risk is necessary. Further research with more robust data is warranted. Summary at a glance: This meta-analysis of kidney transplants from donors after circulatory death (DCD) indicates comparable long-term outcomes with and without donor acute kidney injury (AKI). While delayed graft function is more frequent in AKI grafts, careful donor selection can expand the donor pool without compromising survival.