Single-Center Experience With Complications and Clinical Outcomes of 464 Living Kidney Donors

• We detected development of arterial hypertension among 112 of the 351 (32%) living kidney donors without preexisting arterial hypertension that was associated with male sex, older age, elevated body mass index and elevated cholesterol levels at donation, but did not affect renal function at the follow-up after donation. • A total of 101 (22%) of the 452 available donors with preexisting arterial hypertension before donation experienced a deterioration of renal function with decrease of eGFR at the follow-up of up to 5 years after donation. • We observed a significant reduction of eGFR at the follow-up of 1 year after donation compared to the predonation values whereas proteinuria and albuminuria levels did not change at 1 year post donation. • We found a loss of more than 30% of the baseline renal function related to eGFR determined at donation among 172 of 270 (64%) available donors at 1-year follow-up; this donor subgroup was significantly older and was significantly more likely to exhibit anomalies of renal arteries, preexisting arterial hypertension, hypercholesterolemia, higher BMI levels and lower eGFR values at donation. This retrospective single-center cohort study reports the complications and outcomes experienced by living kidney donors. Our study involved 464 donors who donated a kidney between January 2004 and March 2023 at the University Hospital Essen. Of the 452 available donors having clinical assessment for arterial hypertension, 101 (22%) exhibited arterial hypertension at the time of donation, whereas 112 of the 351 (32%) donors without preexisting arterial hypertension experienced new-onset arterial hypertension at follow-up after donation. The development of arterial hypertension after donation was related to male sex, older age, elevated body mass index (BMI), and elevated cholesterol levels at donation but did not relevantly affect renal function after donation. Preexisting arterial hypertension was associated with a reduction in the estimated glomerular filtration rate (eGFR) and an increase in creatinine levels at donation and over the entire follow-up period. Follow-up at 1 year after donation found that eGFR levels were significantly lower than predonation levels ( P < .0001). No significant changes in the incidence of proteinuria ( P = .20) or albuminuria ( P = .17) were found at 1-year follow-up. At 1 year after donation, 98 of 270 (36%) available donors had retained 70% or more of their baseline renal function related to eGFR determined at donation. Our results suggest an increased risk of new-onset arterial hypertension after living kidney donation. The deterioration of renal function was higher after living kidney donation among donors with preexisting arterial hypertension. Among our cohort of 464 donors, living donation was associated with a reduction in renal function.