*Purpose: The rising prevalence of end-stage renal disease and chronic organ shortage subsequently calls more people upon to consider living kidney donation. Recent data, however, suggest an increased risk of cardiovascular morbidity at least among subgroups of living kidney donors (LKDs), and call for improved risk stratification and donor education.

*Methods: We performed a prospective 5-year follow-up of 276 LKDs undergoing nephrectomy at our center between 1998 and 2013. Donors were assessed in 2013 and 2018. We aimed to address the impact of donation on mental and physical health. Quality of life assessment was performed using the standardized short form 12 questionnaire (SF-12). Nephron numbers were estimated using donor birth weight.

*Results: The response and follow-up rate was 90.2% in 2013 and 80.7% in 2018. Median time after donor nephrectomy was 5 years in 2013 and 10 years in 2018. While 19.2% of LKDs showed pre-existing hypertension at nephrectomy, 28.3% and 34.1% of LKDs developed new-onset hypertension by 2013 and 2018, respectively. 22.1% of hypertensive LKDs showed necessity for three or more antihypertensive drugs. Risk factors that were associated with the development of hypertension post-donation included low estimated nephron number, post-donation weight gain, and family history of hypertension among first degree relatives (p<0.05). 10.2% of LKDs developed prediabetes/diabetes. Risk factors that were associated with the development of diabetes included pre-existing or post-donation hypertension and family history of diabetes among first degree relatives. Median physical and mental component scores (PCS/MCS) of LKDs were 51.2 and 51.3, respectively, and comparable to the general population norm (p>0.05). Impaired PCS and MCS were associated with development of post-donation hypertension, symptoms of fatigue, and chronic pain (p<0.05).

*Conclusions: Our results indicate that low estimated nephron number, post-donation weight gain, and family history for hypertension puts the LKDs at an increased risk for the development of post-donation hypertension. Risk stratification for the development of post-donation hypertension and associated cardiovascular risk needs to be implemented in donor selection, education and long-term follow-up. The impact of post-donation hypertension on quality of life may be related to regular medication and disease awareness.

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