*Purpose: In the general population, pregnancy complications are associated with long-term maternal risk. Kidney donors with postdonation pregnancies have increased risk of gestational HTN and preeclampsia. However, little data exists on whether donors with postdonation pregnancy-related complications have increased long-term risks. In a single-center analysis, we studied whether donors who had postdonation gestational HTN, preeclampsia, or gestational DM were at increased risk of developing HTN, DM, cardiovascular disease (CVD), eGFR<45, or eGFR<30 compared to donors with non-complicated postdonation pregnancies.

*Methods: Post-donation pregnancies with complications were matched one-to-many with pregnancies without complications to compare long-term risk using sequential cox regression with robust standard errors and multiple imputation. Donors with the specified pregnancy complication prior to donation were excluded from the model. Models were adjusted for age at pregnancy, pregnancy number, year of donation, and family history of HTN, DM, and heart disease.

*Results: Of the 400 donors with postdonation pregnancies (median [IQR] follow-up of 27.0 [13.9, 36.2] years after donation), 43 experienced preeclampsia, 31 had gestational HTN without preeclampsia, and 20 had gestational DM. Median interval from donation to pregnancy-related complication was 5.1 [3.1, 8.6] years for preeclampsia, 4.3 [2.1, 8.2] years for gestational HTN, and 7.1 [4.5, 9.2] years for gestational DM. Preeclampsia (HR 2.23, 95%CI: 1.34-3.7; p=0.002) and gestational HTN (HR 2.09, 95%CI: 1.08-4.04; p=0.028) were associated with development of HTN. Gestational DM was associated with development of DM (HR: 5.46, 95% CI: 1.62-18.39; p=0.008). Pregnancy-related complications were not associated with increased risk of CVD, eGFR<45, or eGFR<30

*Conclusions: In our single center study, postdonation preeclampsia, gestational HTN or DM was associated with long-term risk of HTN or DM.

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