*Purpose: Long-term outcomes data of living kidney donors (LKDs) with nephrolithiasis are limited. We assessed the clinical and structural findings and their association with long-term outcomes among LKDs with nephrolithiasis.

*Methods: We performed a multicenter study of LKDs who underwent donor nephrectomy from 1999-2012 with baseline CT scan and implantation biopsy. LKDs ≥ 5 years since donation underwent chart review or completed a long-term follow-up survey for assessment of long-term kidney function – follow-up eGFR by CKD-EPI, residual eGFR (follow-up eGFR/eGFR prior to donation x100%), eGFR <60 and <45 ml/min/BSA - as well as incident (not present prior to donation) hypertension and proteinuria. LKDs with nephrolithiasis (stone formers or SF) were identified by prior history of symptomatic nephrolithiasis (Sx-SF) or by presence of radiographic stone(s) incidentally noted on CT scan during kidney donor evaluation (R-SF). Clinical characteristics, structural findings, and long-term outcomes were compared between SF and non-stone formers (Non-SF) using chi-square or Wilcoxon rank sum test. Univariate and multivariable linear and logistic regression models (with adjustment for age, sex, BMI, and follow-up time) were used to determine the association between stone formation - R-SF only, Sx-SF only, and all SF vs non-SF - and long-term outcomes.

*Results: A total of 866 LKDs (11 Sx-SF, 77 R-SF and 778 Non-SF) were included for analysis. LKDs were 47 +/- 10 years old and 37% male. There were no differences in baseline characteristics between SF and controls. During a median follow-up of 10 (7-12) years, there were no reported adverse renal events (dialysis or listing for transplant). There were no differences in follow-up eGFR, residual eGFR or incident HTN or proteinuria between groups. Multivariable linear regression (Table 1) revealed an association between Sx-SF and higher residual eGFR (p-value=0.0004). There was no association between SF and eGFR <60 or <45, incident HTN, or proteinuria.

*Conclusions: Selected Sx-SF during follow-up may develop higher residual eGFR due to hyperfiltration. Long-term outcomes of selected SF are otherwise similar compared to non-SF.

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