Long Term Outcomes in Living Kidney Donors Over 30 Years
In brief
Only 0.2% of living kidney donors needed dialysis over 12-year follow-up
In a Swiss cohort of 1,863 donors tracked for a median of 12 years, kidney function remained essentially unchanged (average eGFR rise of 0.14 ml/min/1.73 m² per year). Dialysis-dependent kidney failure occurred in three donors (0.2%), and a combined serious renal endpoint affected 2.1%, especially men, older and obese donors, highlighting the need for lifelong monitoring.
- Journal
- Kidney international reports (Q1)
- Published
- 2 July 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Joana Krättli, Deborah Buess, Marie Flohr, Matthias Diebold, Caroline Wehmeier, Daniel Sidler, et al.
- PMID
- 42569397
- DOI
- 10.1016/j.ekir.2026.106690
Why clinicians should know about it
- Picked for Nephrology (paper of the day, 9 August 2026): Long‑term outcomes in living kidney donors
- Picked for Transplantation (paper of the day, 9 August 2026): Prospective cohort, long‑term donor outcomes
Abstract
INTRODUCTION: Living kidney donor transplantation provides major benefits for recipients, but long-term donor safety remains a critical concern. METHODS: We conducted a prospective, multicenter cohort study using data from the Swiss Organ Living-Donor Health Registry. A total of 1863 living kidney donors (1993-2018) with ≥ 5 years of follow-up were followed until death, kidney failure (KF), or last visit (censoring March 31, 2024). Kidney function trajectories from 12 months postdonation onward were analyzed using linear mixed-effects models. A composite secondary end point included early death, dialysis-dependent KF, estimated glomerular filtration rate (eGFR) < 30 ml/min per 1.73 m2, or persistent proteinuria. Risk factors were assessed. RESULTS: A total of 1863 living kidney donors (median age 53 years, 66.2% female) were included; 15.5% had treated arterial hypertension before donation. Median predonation eGFR was 96 ml/min per 1.73 m2, 1% had an eGFR < 60 ml/min per 1.73 m2. Median follow-up was 12 years (interquartile range [IQR]: 7-18 years). Kidney function remained stable, with an average annual eGFR change of +0.14 ml/min per 1.73 m2. Slopes differed by donor characteristics, as follows: women, nonobese, and those without predonation hypertension presented with more stable slopes, whereas obese and hypertensive donors showed attenuated slopes. No differences were observed by age or predonation eGFR. Three donors (0.2%) progressed to dialysis-dependent KF. Overall, 17 donors (0.9%) developed an eGFR < 30 ml/min per 1.73 m2, 28 (1.5%) developed persistent severe proteinuria, and 40 (2.1%) reached the combined end point. Male sex, age, and predonation obesity independently predicted the combined endpoint. CONCLUSION: These findings support safety while underscoring the need for standardized long-term surveillance to optimize donor care and counseling.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.