*Purpose: We studied End Stage Renal Disease diagnosis patterns among prior living kidney donors (PLDs) who received candidate PLD priority on the OPTN kidney waiting list.

*Methods: Transplant programs submit information – including donation date and relationship to recipient – to the OPTN to obtain PLD priority for PLD kidney candidates. We created a novel dataset to study ESRD diagnosis patterns among PLDs on the waiting list 9/1/96-1/31/18; our cohort included 527 PLDs who donated between 1963 and 2011.

*Results: Median donation age was 32 years (IQR:25-40), median age at ESRD onset was 54.8 years (IQR:45.9-63.1), and median time to ESRD onset was 20.8 years (IQR:12.9-28.5). Overall, the most frequent diagnosis was hypertension (33.8%), followed by glomerulonephritis (23.0%), diabetes (17.9%), other diagnoses (11.3%), and unknown (14.0%). Diabetes was most common among Hispanic (25.5%) and other race (33.3%) PLDs, compared with white (17.4%) and black (14.2%). Hypertension and glomerulonephritis were most common among black PLDs (42.6% and 26.8%, respectively). Among PLDs reaching ESRD <10 years post-donation, the most common diagnosis was glomerulonephritis (38.0%). Hypertension was the most common diagnosis 10-20 and 20-30 years post-donation (38.1% and 33.7%, respectively), while the most common diagnoses 30-40 years post-donation were diabetes (37.6%) and hypertension (35.5%). Diagnosis patterns over time since donation varied by race; black and Hispanic PLDs had more glomerulonephritis in the first decade than white PLDs, who had more other diagnoses. For all groups, glomerulonephritis decreased and diabetes increased over time post-donation, but hypertension was substantial in later decades for black PLDs. Time to ESRD diagnosis patterns did not vary by donation year.

*Conclusions: These findings shed light on racial variation in underlying etiologies of ESRD among PLDs.

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