Abstract
Introduction: The persistent shortage of deceased kidney donors in Japan underscores the importance of optimizing donor selection. However, evidence regarding transplant outcomes from donors with impaired renal function remains limited. Methods: This retrospective study used data from the Japan Organ Transplant Network to evaluate 549 adult recipients of deceased donor kidney transplantation from brain-dead donors performed between 2001 and 2022. Death-censored graft survival served as the primary endpoint. Prognostic donor factors were identified, and these variables were incorporated into a nomogram for risk estimation. Results: The median donor age was 50 years, with median serum creatinine concentrations of 0.88 mg/dL at hospital admission and 0.74 mg/dL at organ procurement. Overall, graft survival at 1 year exceeded 90%, including recipients of kidneys from older donors or donors with impaired renal function. In contrast, graft outcomes were less favorable when procurement serum creatinine exceeded 6 mg/dL or donor age was ≥70 years. Younger donors with impaired renal function generally showed favorable outcomes, whereas older donors experienced poorer graft survival despite preserved renal function. Conclusions: Kidneys from donors with impaired renal function may represent an acceptable transplant option, particularly when obtained from younger donors. By contrast, advanced donor age remained associated with less favorable graft outcomes despite preserved renal function. These findings may contribute to more informed donor assessment and clinical decision-making in deceased donor kidney transplantation.