*Purpose: We studied post-donation ESRD in white first-degree related living kidney donors (RLKDs) in the US between 1994 and 2018 (n=45700); this study is the first of its kind to adjust for recipient factors.

*Methods: We ascertained ESRD with OPTN and CMS data and found 115 white first-degree RLKDs developed ESRD through December 2018 (Table 1). There were too few cases in other ethnic groups for these analyses.

*Results: We ran a multivariable Cox proportional hazards regression model and found white RLKDs had increased risk of ESRD if they were male or had higher BMI or higher systolic blood pressure (Figure 1); these findings align with previous studies. However, we also found the first evidence of a recipient factor predicting donor ESRD: an interaction between donor age at donation (yrs older than median donor age) and the related recipient’s age at first onset of ESRD. Among white RLKDs, older donor age was associated with higher risk if the related recipient first developed ESRD at an older age (e.g., at age 55, aHR:1.73, 95% CI:1.23-2.44, p=0.002; Figure 2b), but older donor age was not associated with higher risk if the related recipient developed ESRD at a younger age (e.g., at age 20, aHR:1.09, 95% CI: 0.68-1.73, p=0.71; Figure 2a).

*Conclusions: These findings further inform potential donor risk assessment and illustrate the importance of including relevant family factors in the evaluation and consent of potential RLKDs.

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