*Purpose: Since cigarette smoking is a major risk factor for kidney and cardiovascular disease in the general population, many programs advise living kidney donor candidates who smoke to quit smoking prior to donation, but limited data exist on smoking and post-donation health. We studied the association between smoking and post-donation health in a large cohort of living donors.

*Methods: We assessed estimated glomerular filtration rate (eGFR) trajectories among 1027 donors in the multicenter Wellness and Health Outcomes in Live Donors (WHOLE-DONOR) cohort. eGFR was calculated from serum creatinine values obtained from post-donation medical records; diagnoses were obtained from the medical record and by interview. We modeled eGFR trajectories among three smoking groups (never, prior to donation, or current at time of donation) by mixed-effect linear regression. We used propensity weights to account for covariate imbalance. We modeled risk of post-donation hypertension and diabetes using multivariable Cox regression.

*Results: Among study participants, 15% reported current cigarette use and 28% reported past cigarette use at the time of the donor evaluation. Postdonation eGFR trajectories were comparable across smoking strata (Figure). In weighted/adjusted models, current smokers had slightly higher postdonation eGFR (62.1 mL/min/1.73m²) than nonsmokers (60.8 mL/min/1.73m²). Postdonation eGFR increased over time in all groups; the rate of increase was comparable in never-smokers (0.59 mL/min/1.73m²/yr), former smokers (0.66 mL/min/1.73m²/year), and current smokers (0.85 mL/min/1.73m²/year) (all p>0.1). There was no evidence of increased risk of postdonation hypertension or diabetes among smokers (Table).

*Conclusions: There is no evidence of pre-donation smoking status impacting post-donation health among carefully selected donors.

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