*Purpose: Accurate post-donation renal function prediction is important to minimize the risk of future severe renal function impairment in living kidney donors. Recent studies focused on pre-donation estimated GFR (eGFR) as predictor of pre-donation measured GFR (mGFR) and did not account for the effect of nephrectomy. Therefore, in this study we aimed to identify the predictive value of pre-donation eGFR for post-donation mGFR.

*Methods: In 916 living kidney donors, eGFR (Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)) and mGFR (¹²⁵I-iothalamate) were measured before and 3 months after donation. Bayesian statistics were used to calculate the probability of having a post-donation mGFR above thresholds of 40, 50, and 60 ml/min/1.73m² according to different pre-donation eGFR, age and sex categories.

*Results: Donor age was 52±11 years and 49% were male. Pre-donation eGFR was 88±14 mL/min/1.73m² and pre-donation mGFR/BSA was 101±16 ml/min/1.73m² respectively. Post-donation mGFR/BSA was 64±11 ml/min/1.73m². All donors had a >95% probability to reach a post-donation mGFR ≥40 ml/min/1.73m². All donors with a pre-donation eGFR ≥90 ml/min/1.73m² had a posttest probability >95% of achieving a post-donation mGFR ≥50 ml/min/1.73m². A greater variability in posttest probabilities was seen for the post-donation mGFR threshold set at 60 ml/min/1.73m², with older donors requiring higher pre-donation eGFR values to reach a posttest probability >95%.

*Conclusions: This study shows how pre-donation eGFR can be used to predict post-donation mGFR, taking nephrectomy into account. Compared to young donors, the probability of reaching a high post-donation mGFR had a higher variability for older donors. This model can be used as a supportive device for the clinical decision-making of the individual living kidney donor.

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