*Purpose: KDIGO and others recommend that GFR level acceptance (typically >80 ml/min) should be adjusted for body surface area (BSA) as GFR correlates highly with body size. This probably results in a wider acceptance of those with BSA <1.73 m² and lesser access for those >1.73 m² since adjusted GFR will be higher in the former and lower in the latter. Herein, we describe whether indexing GFR by BSA correlates with long term donor outcomes more accurately than raw GFR.

*Methods: We compared the development of hypertension, proteinuria, reduced eGFR, ESKD and mortality in 5504 donors whose adjusted and raw GFR were >80 ml/min with 256 donors with only adjusted eGFR >80 ml/min, 1086 donors with only raw eGFR >80 ml/min and 1730 with both adjusted and raw <80 ml/min.

*Results: In total 35% of donors had an adjusted eGFR <80 ml/min. Those with adjusted GFR > raw GFR were more likely to be women, had a lower BMI, lower SBP and DBP. Mean follow-up was 16 ± 11 years. The multivariable analysis revealed that donors with both eGFR <80 ml/min are more likely to die and reach eGFR <30 and <45 at last follow-up. Those whom only adjusted eGFR >80 ml/min did not incur increased risks of the outcomes studied. In contrast, donors with only raw GFR >80 ml/min and those with both GFR methods <80 ml/min were more likely to develop an eGFR <45 ml/min during follow-up.

*Conclusions: More women are accepted when adjusted eGFR >80 ml/min is used. Donors with both adjusted and raw <80 ml/min and donors with only raw >80 ml/min were more likely to reach an eGFR <45 ml/min but had similar risk of mortality, hypertension and proteinuria. We see no major advantage for indexing GFR by BSA and it clearly results in over selection of those with smaller body frame.

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