The relationship between predonation eGFR and long-term risk of postdonation ESRD has not been characterized. Moreover, while transplant centers are required to collect postdonation serum creatinine (SCr) in donors, the clinical utility of measuring early post-donation renal function is unknown.

METHODS: Using SRTR data, we studied ESRD risk in 66,052 LKDs 1999-2015 who were ESRD-free 9 months post-donation and had at least one SCr reported to the registry between 3 and 9 months post-donation (6m-post eGFR), using Cox regression and adjusting for donor age, sex, race (black vs all other), 1st-degree biological relationship to recipient, and BMI. Predonation eGFR and 6m-post eGFR were calculated using the CKD-EPI equation.

RESULTS: Donor eGFR declined from median (IQR) 98 (84-110) mL/min/1.73 m2 predonation to 63 (54-74) mL/min/1.73 m2 6m-post (Figure 1). A 10-unit increase in predonation eGFR was associated with 17% decreased risk of ESRD (aHR=_0.70 0.83 _0.99, p=0.04) (Figure 2). In a separate model, a 10-unit increase in 6m-post eGFR was associated with 40% decreased risk of ESRD (aHR=_0.46 0.60 _0.79, p<0.001) (Figure 2). In a combined model, the association between predonation eGFR and ESRD risk disappeared (aHR per 10u=_0.79 0.98 _1.21, p=0.9) while the association between 6m-post eGFR and ESRD risk remained the same (aHR per 10u=_0.44 0.61 _0.83, p<0.001), suggesting that the association between predonation eGFR and ESRD is fully mediated by 6m-post eGFR.

CONCLUSIONS: Both predonation and 6m-post eGFR are inversely associated with postdonation ESRD risk in LKDs. Careful monitoring of early postdonation eGFR is essential to provide adequate postdonation care and counseling.

CITATION INFORMATION: Massie A., Fahmy L., Henderson M., Thomas A., Snyder J., Segev D. Pre-Donation eGFR, Early Post-Donation eGFR, and Subsequent ESRD Risk in Living Kidney Donors Am J Transplant. 2017;17 (suppl 3).

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