Lenain R, Prouteau C, Hamroun A, et al. - Findings from this observational cohort study of adult patients represented within the French CRISTAL registry who received a single kidney allograft from brain-dead deceased donors indicated a reduced graft survival in correlation with deceased donor ongoing acute kidney injury (AKI), undetermined AKI/chronic kidney disease (CKD), and recovery from AKI according to back-estimated baseline serum creatinine (Scr). Defining baseline Scr as the first value determined on admission would have resulted in a misclassification bias and erroneous estimates.

• For an assumed glomerular filtration rate at 75 mL/min/1.73 m², researchers derived a back-estimated MDRD Study equation-derived Scr baseline value.

• Implementation of a refined classification system for donor AKI was done as follows: no AKI, undetermined AKI/chronic kidney disease (CKD), recovery from AKI, and ongoing AKI.

• Classification of 26,786 recipients was done.

• During a median follow-up of 5.7 years, there were 4,458 kidney graft losses.

• An increased risk of graft failure was observed in correlation with deceased donor ongoing AKI when compared with no-AKI.

• The undetermined AKI/CKD and recovery from AKI groups had similar HRs for graft failure to that observed in the ongoing AKI group