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Introduction: The study purpose was to review retrospectively our single‐center experience transplanting kidneys from deceased donors (DD) with acute kidney injury (AKI) according to terminal serum creatinine (tSCr) level. Methods: AKI kidneys were defined by a doubling of the DD's admission SCr and a tSCr ≥ 2.0 mg/dL. Results: From 1/07 to 11/21, we transplanted 236 AKI DD kidneys, including 100 with a tSCr ≥ 3.0 mg/dL (high SCr AKI group, mean tSCr 4.2 mg/dL), and the remaining 136 from DDs with a tSCr of 2.0–2.99 mg/dL (lower SCr AKI group, mean tSCr 2.4 mg/dL). These two AKI groups were compared to 996 concurrent control patients receiving DD kidneys with a tSCr < 1.0 mg/dL. Mean follow‐up was 69 months. Delayed graft function (DGF) rates were 51% versus 46% versus 29% (p < 0.0001), and 5‐year patient and death‐censored kidney graft survival rates were 96.8% versus 83.5% versus 82.2% (p = 0.002) and 86.7% versus 77.8% versus 78.8% (p = 0.18) in the high tSCr AKI versus lower tSCr AKI versus control groups, respectively. Conclusions: Despite a higher incidence of DGF, patients receiving kidneys from DDs with tSCr levels ≥3.0 mg/dL have acceptable medium‐term outcomes compared to either AKI DDs with a lower tSCr or DDs with a tSCr < 1.0 mg/dL. [ABSTRACT FROM AUTHOR]

Introduction: Long‐term outcomes of kidney transplantation from deceased donors (DDKTs) with terminal acute kidney injury (AKI) are not well defined. Methods: Single center retrospective review of DDKTs from 1/31/07‐12/31/19. AKI kidneys were defined by a doubling of the donor's admission serum creatinine (SCr) level AND a terminal SCr ≥2.0 mg/dl. Results: A total of 188 AKI DDKTs were performed, including 154 from brain‐dead standard criteria donors (SCD). Mean donor age was 36 years and mean Kidney Donor Profile Index was 50%; mean admission and terminal SCr levels were 1.3 and 3.1 mg/dl, respectively. With a mean follow‐up of 94 months (median 89 months), overall patient (both 71.3%) and graft survival (54% AKI vs. 57% non‐AKI) rates were comparable to concurrent DDKTs from brain‐dead non‐AKI SCDs (n = 769). Delayed graft function (DGF) was higher in AKI kidney recipients (47% vs. 20% non‐AKI DDKTs, p <.0001). DGF was associated with lower graft survival in recipients of both AKI and non‐AKI SCD kidneys but the impact was earlier and more pronounced in non‐AKI recipients. Conclusions: Despite having more than twice the incidence of DGF, kidneys from deceased donors with terminal AKI have long‐term outcomes comparable to non‐AKI SCD kidneys and represent a safe and effective method to expand the donor pool. [ABSTRACT FROM AUTHOR]

Introduction: The influence of sex on outcomes following simultaneous pancreas–kidney transplantation (SPKT) in the modern era is uncertain. Methods: We retrospectively studied 255 patients undergoing SPKT from 11/2001 to 8/2020. Cases were stratified according to donor (D) sex, recipient (R) sex, 4 D/R sex categories, and D/R sex‐matched versus mismatched. Results: D‐male was associated with slightly higher patient (p =.08) and kidney (p =.002) but not pancreas (p =.23) graft survival rates (GSR) compared to D‐female. There were no differences in recipient outcomes other than slightly higher pancreas thrombosis (8% R‐female vs. 4.2% R‐male, p =.28) and early relaparotomy rates in female recipients (38% R‐female vs. 29% R‐male, p =.14). When analyzing the 4 D/R sex categories, the two D‐male groups had higher kidney GSRs compared to the two D‐female groups (p =.01) whereas early relaparotomy and pancreas thrombosis rates were numerically higher in the D‐female/R‐female group compared to the other three groups. Finally, there were no significant differences in outcomes between sex‐matched and sex‐mismatched groups although overall survival outcomes were lower with female donors irrespective of recipient sex. Conclusions: The influence of D/R sex following SPKT is subject to multiple confounding issues but survival rates appear to be higher in D‐male/R‐male and lower in D‐female/R‐male categories. [ABSTRACT FROM AUTHOR]

Following simultaneous pancreas‐kidney transplantation (SPKT), survival outcomes are reported as equivalent in patients with detectable pretransplant C‐peptide levels (Cp+) and a "type 2″ diabetes mellitus (DM) phenotype compared to type 1 (Cp negative [Cp‐]) DM. We retrospectively compared 46 Cp+ patients pretransplant (≥2.0 ng/mL, mean 5.4 ng/mL) to 46 Cp‐ (level < 0.5 ng/mL) case controls matched for recipient age, gender, race, and transplant date. Early outcomes were comparable. Actual 5‐year patient survival (91% versus 94%), kidney graft survival (69% versus 86%, p =.15), and pancreas graft survival (60% versus 86%, p =.03) rates were lower in Cp+ versus Cp‐ patients, respectively. The Cp+ group had more pancreas graft failures due to insulin resistance (13% Cp+ versus 0% Cp‐, p =.026) or rejection (17% Cp+ versus 6.5% Cp‐, p =.2). Post‐transplant weight gain > 5 kg occurred in 72% of Cp+ versus 26% of Cp‐ patients (p =.0001). In patients with functioning grafts, mean one‐year post‐transplant HbA1c levels (5.0 Cp+ versus 5.2% Cp‐) were comparable, whereas Cp levels were higher in Cp+ patients (5.0 Cp+ versus 2.6 ng/mL Cp‐). In this matched case‐control study, outcomes were inferior in Cp+ compared to Cp‐ patients following SPKT, with post‐transplant weight gain, insulin resistance, and rejection as potential mitigating factors. [ABSTRACT FROM AUTHOR]