*Purpose: Recently, medically complex living donors with marginal factors including hypertension, dyslipidemia, glucose intolerance, and obesity are increasing. The impact of preoperative marginal factors on medically complex living donors after operation has not been investigated. We investigated the pathological findings of control biopsy, postoperative kidney functions, and mortality of the medically complex living donors.

*Methods: Between January 2008 and December 2016, 805 living donors for kidney transplantation were included in this study. Marginal criteria for medically complex living donors include hypertension, dyslipidemia, glucose intolerance, and obesity. Living donors were stratified into 2 groups (healthy living donor and medically complex living donor). 215, and 590 living donors were classified into healthy living donor and medically complex living donor, respectively. Pathological findings of baseline biopsy, postoperative estimated glomerular filtration rates (eGFR), proteinuria, and mortality were compared.

*Results: Pathological findings of baseline biopsy presented no significant difference in interstitial fibrosis, tubular atrophy, obsolescent glomerulus or arteriolosclerosis (P=0.093). In postoperative eGFRs and urine protein content over a 24 h period, no significant difference was identified in each point of observation periods.

No significant difference was identified in mortality.

*Conclusions: Preoperative marginal factors do not affect the clinical course of medically complex living donors after operation.

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