*Purpose: Living donor kidney transplantation is being increasingly performed with elderly donors. Such elderly donors often have arteriosclerotic lesions (AS) (Figure 1). Whether the outcomes of living donor kidney transplantation in donors with renal artery AS can be predicted by preoperative computed tomography (CT) is unclear. In transplantation from a donor with renal artery AS, we aim to show the outcome of donors and recipients after transplantation.

*Methods: We examined 63 living donor kidney transplantations that had been performed since November 2013. We compared the outcomes between 17 procedures performed with a donor with renal artery AS on CT (group A) and 46 procedures with donors without AS (group B).

*Results: The age of the donors in group A was significantly older than those in group B (73 years vs. 59 years, p <0.001). The number of donors with a history of hypertension was higher in group A (52.9 % vs. 19.6 %, p <0.05). There was no significant difference in body mass index and amount of body fat or muscle between both groups. While the harvested renal volume tended to be small in group A, the residual renal volume was significantly smaller (135.7 cm³ vs. 152.2 cm³, p <0.05). The postoperative donors’ estimated glomerular filtration (eGFR) and the recipients’ renal function was significantly inferior in group A. There was no significant difference in the graft survival rate between the two groups. When comparing donors over the age of 60 [12 recipients with AS (group A’) and 14 recipients without AS (group B’)], there was no significant difference in the history of hypertension, the harvested renal volume, and the residual renal volume. However, the postoperative donors’ eGFR was significantly inferior in group A’. There were no significant differences in the function and survival rate of the transplanted graft.

*Conclusions: The presence of renal AS on preoperative CT may predict decreased renal function after donation.

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