*Purpose: Follow-up after living kidney donation in the United States has improved with recent policy mandates. We hypothesized that lack of insurance at donation may be a barrier to postdonation follow-up.

*Methods: We examined Scientific Registry of Transplant Recipients (SRTR) data for 90.460 living kidney donors (LKD) in 2004-2018 to examine associations (adjusted odds ratio, aOR) of insurance status and other baseline factors with clinical and laboratory follow-up after donation.

*Results: Follow-up increased over time, and was especially high in older LKD. Follow-up was lower in uninsured compared to insured LKD over time, including in the era of the Affordable Care Act (Fig. A). In 2018, for uninsured vs insured LKD, respectively, clinical follow-up was 87.5% vs 90.4% at 6-months, and 76% vs 86.7% at 12-months, while 12-month lab follow-up was 55.4% vs 68.4%.

In multivariate regression including adjustment for donation year and other baseline factors, uninsured status was associated with 7% lower odds of 6-month clinical follow-up (aOR, 0.93) and 14% lower odd of lab follow-up (aOR, 0.86). Follow-up was also significantly (P<0.05) lower for LKD who were African American (aOR 0.85) or Hispanic (aOR 0.91), unrelated to their recipient (aOR 0.85), not working (aOR 0.81) and with less than college education (Fig. B).

Associations were similar for 1-year follow-up.

*Conclusions: While follow-up after living kidney donation is improving, uninsured LKD and those who are non-white, unemployed, and with lower education are less likely to receive follow-up. Novel initiatives are needed to provide access to follow-up care for at-risk LKD, including the uninsured and under-insured, to minimize the risk of socioeconomic disparities in long-term postdonation outcomes.

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