The Impact of Living Kidney Donor Glomerular Filtration Rate on Graft Survival

<i>Background and Objectives:</i> Kidney transplantation (KT) is the gold-standard treatment for end-stage renal disease (ESRD). An accurate evaluation of donor renal function is critical for living kidney transplantation. This study aimed to assess the impact of donor glomerular filtration rate (GFR) on long-term graft function and survival. <i>Materials and Methods:</i> A retrospective analysis was conducted on 229 donor-recipient pairs who underwent living kidney transplantation at our center. Data on recipient demographics, clinical characteristics, and donor GFR were collected. The outcomes of graft survival were compared based on donor and recipient characteristics. Logistic regression was used to identify the factors influencing graft loss. <i>Results:</i> Mortality was significantly higher in the graft loss group (26% vs. 5.1%, <i>p</i> = 0.001). Graft biopsy was associated with a 24.74-fold increased risk of graft loss (95% CI: 5.387-113.609, <i>p</i> < 0.001). Each 1 mL/min/1.73 m² increase in donor GFR reduced graft loss risk by 0.075% (95% CI: 0.870-0.983, <i>p</i> = 0.013). Donor age, gender, and BMI showed no significant impact on graft survival. <i>Conclusions:</i> A higher donor GFR positively influenced graft survival. However, donor age, gender, and BMI did not significantly affect long-term outcomes. These findings emphasize the importance of thorough donor evaluation to optimize graft survival and recipient outcomes.