*Purpose: The low estimated glomerular filtration rate (eGFR) at 1 year after kidney transplantation was demonstrated to be the risk for graft failure in the previous reports. However, the impact of eGFR within 1 year has not been fully investigated. We investigated the impact of eGFR within 1 year after living donor kidney transplantation (LDKT) on the risk of graft failure.

*Methods: This retrospective cohort study included 1083 recipients who underwent LDKT between January 2008 and December 2019. The mean follow up period was 81.2±42.1 months. During the observation period, seventy three graft failure and forty one death with functioning graft were identified. To investigate the impact eGFR within 1 year on graft failure, a Fine-Grey completing risk regression model was used. The univariate Fine-Grey completing risk regression model was analyzed for recipient age, recipient sex, cause of ESRD, recipient BMI, transplantation from first-degree relative donor, preoperative flow cytometry crossmatch (T-cell and B-cell), dialysis vintage, preoperative sensitization, HLA-AB mismatch, HLA-DR mismatch, PRA class I positive (≥ 5%), preoperative PRA class II positive (≥ 5%), ABO-incompatible transplantation, preformed DSA, preoperative conditioning, immunosuppressive medications at transplantation, postoperative eGFR (at 1w, 2w, 3w, 3M, 6M, 12M), donor age, donor sex, donor BMI, baseline biopsy findings 1 h post transplantation, more than one preoperative comorbidity, smoking history, preoperative eGFR, kidney side, kidney weight, warm ischemic time, donor operation time, donor operation blood loss, operation methods of donor nephrectomy, and cold ischemic time. The variables with P-values < 0.05 were used for the multivariate analysis.

*Results: In the univariate analysis, significant differences were identified in preformed DSA, preoperative conditioning, recipient sex, donor age, postoperative eGFR at 6M and 12M. In the multivariate analysis, significant differences were identified in postoperative eGFR at 6M (P=0.015, hazard ratio [HR] 0.946, 95% confidence interval [CI] 0.905 – 0.989) and 12M (P<0.001, HR 0.937, 95% CI 0.907 - 0.967).

*Conclusions: The low eGFRs at 6 and 12 months after living kidney transplantation were demonstrated to be an independent risk for graft failure. However, eGFRs before 6 months could not be the risk for graft failure.

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