Prevalence of Obesity After Living Kidney Donation and Associated Risk Factors: Cardiovascular and Renal Implications

Background: Living kidney donor (LKD) transplantation contributes to mitigating the organ shortage and some programs now accept donors with borderline criteria, such as obesity. However, the long-term impact of these criteria extension remains unclear. Methods: This study retrospectively analyzed 306 LKD from 1998 to 2020 to examine obesity trends, predictors, and impact on cardiovascular risk and kidney function. Results: Before donation, 49% of donors were normal weight, 41% were overweight, and 10% were obese. Obese donors were older (50.8 ± 8.8 years, p = 0.009) and had higher rates of dyslipidemia and hypertension (41%, p < 0.001 for both). Over 9 years, obesity rates were stable (8.8-14.8%). A mixed logistic regression model showed that dyslipidemia (OR 6.1, p = 0.042), age (OR 0.9, p = 0.005) and body mass index (OR 5.3, p < 0.001) were strong predictors of post-donation obesity. Overweight donors showed an increase in obesity rates over time in the McNemar's paired analysis [14% obesity by year 3 (p = 0.001); 12.5% at year 10 (p = 0.014)]. Post-donation hypertension was more prevalent in obese donors' (61.1% vs. 30.4%, p = 0.011), though proteinuria and estimated glomerular filtration rate (eGFR) did not differ significantly. Conclusions: These findings show that pre-donation overweight, younger age, and dyslipidemia predict post-donation obesity, with hypertension posing added risk for obese donors. There was no impact concerning proteinuria and eGFR. The study underscores the importance of careful donor selection and risk informed counseling.