*Purpose: In general, hypertension (HTN), proteinuria, or diabetes (DM) are exclusion criteria for living kidney donation in young candidates. Exceptions are made for conditions only experienced during pregnancy. In the general population, disorders of pregnancy are associated with increased long-term risk. There is little data on outcomes of women who had these complications and subsequently become donors. In a single-center analysis, we studied whether kidney donors who had pre-donation pregnancy complications (gestational HTN, preeclampsia, or gestational DM) were at increased risk of developing HTN, DM, and cardiovascular disease (CVD).

*Methods: Donors with the specified pre-donation complication were matched 1:10 to donors with pre-donation pregnancies without the complication using nearest neighbor propensity score matching. Propensity scores were estimated using logistic regression with covariates for systolic BP, glucose, BMI, age, and creatinine at the time of donation, donation year, relationship to recipient, and family history of HTN, DM, and heart disease. Incidence of outcomes were compared between groups using proportional hazards models.

*Results: Of 1590 donors with pre-donation pregnancies, 47 had preeclampsia, 28 had gestational HTN without preeclampsia, and 36 had gestational DM. Matching led to good balance with SMDs < 0.1. Mean (SD) follow-up of those with pre-donation complications was 20.8 (12.8) years. Gestational HTN was associated with development of HTN (HR: 2.06, 95% CI: 1.25-3.40; p=0.004) and DM (HR: 2.92, 95% CI: 1.25-6.82; p=0.013). Gestational DM was associated with development of DM (HR: 4.17, 95% CI: 1.84-9.46; p=0.001). We did not detect associations between pregnancy complications and development of CVD or between preeclampsia and any of the outcomes.

*Conclusions: In our single center study we found that among donors, who met screening criteria at the time of donation, having pre-donation gestational HTN or DM was associated with long-term risk. If confirmed by other centers: a) this data should be part of informed consent and b) accepting such candidates as donors should be done with caution.

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