*Purpose: Current data suggest that hypertensive donors can be considered for donation; however, the additive adverse effect of obesity and the risk of failing Glomerular Filtration Rate (GFR) compensation in the remaining kidney remains under-studied.

*Methods: Using data from United States Organ Procurement and Transplantation Network, all donors between 2000 and 2014 were retrospectively reviewed. Data including donor hypertension status, age, sex, body mass index and number of hypertensive medications were collected with follow up of 5 years post-donation. Based on pre-donation diagnosis of hypertension, donors were divided into two groups: hypertensive and non-hypertensive donors. Groups were further stratified according to their body mass index (BMI) into <30 and >30 kg/m². Inverse probability weights were used to adjust confounders among different groups using propensity score analysis. Cox hazard regression analysis for adjusted data and treatment effects model were used to assess outcomes.

*Results: Out of 129689 donors, 2285 had hypertension, 59.5 % were females and 34244 had BMI >30kg/m². Among those with age <50 years, pre-existing hypertension was associated with a major 24-fold increased risk of no GFR compensation of the remaining kidney over 5 years post-donation (OR: 24.2, 95% CI:1.49-393.68; p=0.025). Among hypertensive donors with BMI>30, their risk increased further by 2.8 fold (OR: 2.8, CI: 1.09-7.36; p=0.033). Severity of hypertension as determined by number of blood pressure medications was associated with worse outcome.

*Conclusions: Both hypertension and obesity have major adverse impact on compensatory GFR rise in living donors over five years. The additive effects of these should be well understood, when counselling these patients regarding kidney donation.

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