*Purpose: Kidney transplant programs in Saudi Arabia (KSA) are predominantly based on living kidney donation. Sickle cell trait (SCT) is prevalent in the Eastern and Southwestern provinces of KSA. Renal abnormalities related to sickle trait range from isosthenuria, hematuria to the rare presentation of medullary renal carcinoma. Little is known, however, about the potential risk associated with sickle cell trait in live kidney donors (LKDs). Our aim was to study the clinical outcomes of LKDs with SCT as compared to those without SCT.

*Methods: A retrospective chart review of all LKDs at our transplant center between January 2009 and December 2018. Positive Sickling tests were confirmed by hemoglobin electrophoresis. Pre-donation data on type of transplant (related or unrelated), age, sex, body mass index (BMI), kidney function and hemoglobin were collected. Dipstick urine examination with focus on specific gravity (SG), blood and protein were also included. Post-donation data on eGFR at 1, 3 and 5 years were collected, in addition to hemoglobin and results of urine examination.

*Results: 63 LKDs with SCT were identified (mean age at time of donation 32 years (±SD:8.), 38 (60%) males), and these were compared with 125 donors without SCT (mean age 31 years (±SD:7.7), 80 (64%) males). The two groups were also matched for BMI and pre donation eGFR. 59 donors with SCT were biologically related to the recipients. 7 of SCT donors (11%) had low SG (below 1.01) and 3 had isolated microscopic hematuria (renal biopsy confirmed thin basement membrane disease in 2, the other had normal renal biopsy). Pre donation mean eGFR was 112 ml/min/1.73 m2 (±SD:14) ) in the SCT group vs 118 ml/min/1.73 m2 (±SD:13.5) in non-SCT LKD’s. Mean follow up was 4 years. In the SCT group, the mean eGFR at 1, 3 and 5-years post donation was 77 (±SD:3.2), 80 (±SD: 6.5) and 82(±SD: 14.6) ml/min/1.73 m2 (vs 83(±SD:6), 84(±SD:9) and 83(±SD:16) ml/min/1.73 m2 in the non-SCT group . Among SCT donors with low urine SG (n=7), 2 of continued, while another 6 SCT donors started to have low urine SG during follow-up.

*Conclusions: Living kidney donors with sickle cell trait demonstrated comparable eGFR level to non-sickle trait kidney donors, and although longer term outcome data is required, sickle cell trait donors may be able to contribute to the living kidney donor pool in this high sickle cell prevalence area.

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