Long-Term Follow-Up of Kidney Donors in a Tertiary Care Hospital

To estimate the proportion of living kidney donors (completed one year post-donation) who have developed proteinuria, an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m², hypertension, or suboptimal renal compensation (defined as <70% of pre-donation glomerular filtration rate (GFR)) during post-donation follow-up. The study also aimed to evaluate the association between donor-related factors and clinical outcomes. To assess the emotional well-being and overall satisfaction of donors through structured, in-person interviews.

A cross-sectional prospective study design was undertaken to contact all donors of recipients under regular review who had completed at least one year post-donation. Among approximately 250 living renal transplant recipients in active follow-up, about 200 corresponding donors had crossed the one-year post-donation period. Of these, 160 donors responded to the call for follow-up, and 140 completed a comprehensive clinical and laboratory assessment in accordance with the institutional follow-up protocol. Written informed consent was obtained from all participants, and pre-donation records were retrieved for comparative analysis. The emotional well-being and overall satisfaction of donors were assessed through structured, in-person (in formal) interviews. Results were analyzed with IBM SPSS Statistics Software, version 20.0 (IBM Corp., Armonk, New York, USA).

The mean age at donation was 45.4 ± 9.4 years (range: 20-69 years), and the mean age at follow-up was 51.5 ± 9.9 years. The median duration of follow-up was 7 ± 4 years (interquartile range (IQR): 1-23 years), with 30% (n = 42) of donors followed for more than 10 years post-donation. Female donors predominated (77.2%; n = 108), yielding a female-to-male ratio of approximately 3.4:1. Mothers constituted the largest donor subgroup (52.8%; n = 74). Perioperative complications occurred in 8% (n = 7) of donors. Hypertension was noted in 34 (24.3%). Proteinuria (protein-to-creatinine ratio (PCR) > 0.2) was seen in 34 donors (24.3%). Mean eGFR pre- and post-donation was 91.6 ± 16.0 ml/min and 80.3 ± 18.5 ml/min, with a decline of 11 ml/min. One hundred twenty-two donors (87.1%) have eGFR >60 ml/min/1.73 m². Overall, 84.3% (n = 118) achieved optimal and 15.7% (n = 22) showed suboptimal compensation. On multivariate analysis, only suboptimal renal compensation remained an independent predictor of eGFR < 60 ml/min (adjusted OR: 31.43; 95% CI: 7.19-137.2; p < 0.001). Neither donor age nor gender showed a significant association with outcomes such as proteinuria, hypertension, eGFR <60 mL/min/1.73 m²,and suboptimal compensation. A vast majority (91%, n = 127) expressed happiness and complete satisfaction with their decision to donate.

In this cohort, female predominance reflected persistent sociocultural patterns. The prevalence of hypertension was comparable to that of the general population. These findings reinforce that modest post-donation changes in proteinuria or eGFR should not discourage donation, given its profound benefits to recipients, donors, and society. Establishing dedicated renal donor clinics for structured, lifelong surveillance is vital to safeguard donor health.