*Purpose: Many people with hypertension are excluded from kidney donation fearing that hypertension is a major cause of CKD and its impact maybe magnified after nephrectomy. Such practice is not fully supported by strong evidence and may deprive some the benefit of a live donor transplant.

*Methods: In a retrospective analysis of 8721 ethnically diverse kidney donors of whom 904 were hypertensive at donation, we compared long-term outcomes of hypertensive kidney donors to those without hypertension at the time of donation. All donations took place 1963-2007. Study outcomes were mortality, cardiovascular disease, proteinuria, and ESRD.

*Results: Median age was 39 years, 56.2% were women, 85% were non-Hispanic white, and 80.5% were related donors. At donation, 904 donors were hypertensive; receiving antihypertensive medications (n=251) or had a blood pressure >140/90 mmHg (n=653). Hypertensive donors were older, 58.2% were <50 years old and had a lower eGFR at donation. After 7 ±10 years, an additional 26% of donors developed hypertension. Donors with new hypertension were younger at donation and were less likely to be related to the recipient. The 30-year cumulative incidence of ESRD was 213/10000 in hypertensive donors vs. 342/10000 in normotensive donors. The multivariable risk of mortality, CVD and proteinuria were comparable in normotensive and hypertensive donors. In total, 5 hypertensive donors and 39 normotensive donors developed ESRD 19.2 ±10.3 years after donation, aHR 0.42 (0.08-2.07), p=.29 in the Cox model and aOR 1.04 (0.36-3.0), p=0.95 in the multiple regression model. Sensitivity analysis using the new definition of hypertension (>130/80) yielded similar results.

*Conclusions: Kidney donors with hypertension do not appear to incur higher mortality, CVD, or ESRD. Wider acceptance of well screened hypertensive kidney donors appears reasonable and could safely expand live donation.

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