*Purpose: There is limited knowledge regarding long-term cardiovascular outcomes in living kidney donors. We performed a multicenter study assessing baseline risk factors that increase MACE post-living kidney donation.

*Methods: We prospectively followed LKDs who donated from 1999 to 2012 and who completed a survey between 2017 and 2019. MACE were defined as having any of the following post-donation events: coronary artery disease (CAD), heart failure (HF), myocardial infarction (MI), coronary stenting, coronary artery bypass graft surgery (CABG), stroke, transient ischemic attack or peripheral artery bypass surgery. Obesity, metabolic syndrome, hypertension (HTN), hypertriglyceridemia, hyperuricemia, high LDL (>130mg/dl), low HDL, active smoking and impaired fasting glucose were assessed as baseline risk factors. Logistic regression was used for analysis after adjusting for age, sex and time from donation.

*Results: A total of 824 LKDs were included. 36 (4.37%) LKDs had a MACE with a mean follow up of 10.7 years (0.41 events per 100 person years). This included 17 (2.1%) CAD, 5 (0.6%) HF, 9 (1.1%) MI, 12 (1.5%) coronary stenting, 4 (0.5%) CABG, 5 (0.6%) stroke, 8 (1.0%) TIA and 3 (0.4%) leg bypass surgery. Smoking (OR=2.84, p=0.027), age predonation (OR=1.81, p=0.0002) and longer time from donation (OR=3.01, p=0.0001) were the only risk factors for MACE in the unadjusted and adjusted model (Table 1).

*Conclusions: LKDs are generally healthy and at low risk for developing MACE despite donating a kidney, however tobacco smoking cessation should be encouraged in potential LKDs.

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