*Purpose: The degree of chronic histopathologic changes in renal allografts, including interstitial fibrosis, tubular atrophy, and arteriolar hyalinosis, can have clinical implications in long-term allograft function and in the residual renal function of living donors. Since there is a risk of procedural complications with renal biopsies, identifying a noninvasive marker that can predict the extent of chronic renal damage may serve as a useful tool for donors in better understanding their risk of developing chronic kidney disease post-donation. We examined living donor characteristics to identify potential clinical predictors of chronic renal lesions.

*Methods: This was a single-center, retrospective analysis of 155 living renal transplant donors. 1-hour post-perfusion renal biopsies were reviewed to determine chronic renal changes. We identified kidneys with chronic interstitial fibrosis and tubular atrophy (ci+ct) score of > 1 and arteriolar hyalinosis (ah) score of > 1 as a risk factor for subordinate renal function recovery in the previous study. Thus, we divided the 155 donors into two groups; chronic change (CC) group (n=21) with ci+ct > 1 and ah > 1 as well as the rest of donors as a control group (n=134). We examined age, sex, tobacco use, blood pressure, hemoglobin A1c (HbA1c), uric acid, low-density lipoprotein (LDL), aortic calcification index (ACI), body mass index (BMI), and 3^rd lumber iliopsoas muscle index as possible predictive factors. Mann-Whitney’s U test, multivariate logistic regression, and receiver operating characteristic curve were used for analysis.

*Results: Out of the 155 donors, 53 (34.2%) were male and 102 (65.8%) were female. Male donors were 24-78 years of age with median BMI of 23.9, median HbA1c of 5.7%, and median eGFR of 115.7 ml/min/1.73m². Female donors were 33-79 years old and had median BMI of 22.3, median HbA1c of 5.6%, and median eGFR of 108.4 ml/min/1.73m². There was no significant difference in age, BMI, HbA1c, and eGFR between the two genders. However, there was a significant difference in HbA1c between the chronic changes group and the control group in male donors (chronic change group 6.02+ 0.18 vs control group 5.7+ 0.54, p=0.032). Multivariate analysis also showed that HbA1c was significantly different between the two groups for male donors (odds ratio 1.25, 95%CI: 1.01-1.54 per 0.1% p=0.039). Cut-off value of HbA1c was 6.05% (AUC 0.737, p=0.034). No significant difference in HbA1c was found between the two groups for female donors. Ci+ct score positively correlated with HbA1c (p=0.015) and BMI (p=0.007) in male donors, and ah score was in positive correlation with age (p=0.003) and LDL (p=0.007) in female donors.

*Conclusions: Male donors with chronic lesions on biopsies were noted to have higher HbA1c. Although HbA1c value may meet criteria for living donation, this may serve as a possible marker for identifying those who may be at higher risk of developing chronic kidney diseases in the future.

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