Background: Baseline chronic donor kidney injury is usually scored using Remuzzi’s classification. It has been suggested that kidneys with Remuzzi scores of 0-3 can be transplanted singly. The kidney function and graft survival of renal grafts from donation after cardiac death (DCD) donors with Remuzzi scores of 4-5 in solitary kidney transplantation is unknown. Methods Preimplant kidney biopsy for 145 consecutive, solitary, DCD kidneys transplanted at our center from July 2013 to December 2016 was retrospectively reviewed. Kidneys with Remuzzi scores of 4-5 were accepted for solitary kidney transplantation in our center if the donors’ terminal serum creatinine clearance > 60 ml/min (Cockcroft formula).
Results: The 12 months estimated glomerular filtration rate (eGFR, by the CKD-EPI equation) of renal grafts with Remuzzi score of 0-3 was significantly higher than grafts with Remuzzi score of 4-5 (76.3 ± 21.4 ml/min vs. 44.0 ± 10.9 ml/min，P＜0.001). The 12 months eGFR of renal grafts with Remuzzi score of 3 was significantly higher than grafts with Remuzzi score of 4 or 5 (P＜0.01) . With a follow-up of 14-40 months, Kaplan-Meier analysis showed that there were no statistical differences in graft survival between kidneys with Remuzzi score 0-3 and 4-5. Conclusions Kidneys from DCD donors with Remuzzi score 4-5 have worse graft function at one year after solitary kidney transplantation but with acceptable short-term graft survival.