Long-Term Outcomes of Living Kidney Donors in a Developing Country: A Single-Center Study

<b>Background/Objectives</b>: Kidney transplantation remains the most effective treatment for patients with end-stage kidney disease, increasing both survival and quality of life. There are concerns regarding the long-term outcomes of donors in developing countries, as kidney transplants are predominantly performed from living donors. This study was conducted to evaluate the long-term clinical outcomes of living kidney donors, with a particular focus on kidney and cardiovascular health. <b>Methods</b>: We retrospectively reviewed the records of 232 individuals who underwent donor nephrectomy between January 2011 and November 2022. Cardiovascular events, mortality, chronic kidney disease, hypertension, and newly onset diabetes were assessed. Estimated glomerular filtration rate (eGFR) values were employed to monitor kidney function over time. <b>Results</b>: Living kidney donors were monitored for a median of 6 years (IQR: 4-9 years). During the follow-up period, 18.9% of donors experienced a decline in eGFR to below 60 mL/min/1.73 m²; however, none progressed to end-stage kidney disease. Of the cohort, 20 (8.6%) had newly onset proteinuria and none had proteinuria before transplantation. Although there were no recorded deaths from cardiovascular causes, 4.3% of donors experienced major adverse cardiac events. 12.3% of donors had newly diagnosed hypertension following transplantation, and 20.2% of donors had hypertension overall. Lower baseline eGFR, treated as a continuous variable in the logistic regression model, was independently associated with a higher likelihood of post-donation eGFR < 60 mL/min/1.73 m² (OR: 0.91; 95% CI: 0.88-0.94; <i>p</i> < 0.001). Post donation proteinuria (OR: 6.61; 95% CI: 1.98-22.07, <i>p</i>: 0.002) was also identified as independent risk factors for decline in eGFR to below 60 mL/min/1.73 m². Diabetes mellitus was found to be a significant predictor of newly onset hypertension. <b>Conclusions</b>: A considerable percentage of the donors experienced gradual deterioration in kidney function, even though none of them developed kidney failure necessitating dialysis. The prevalence of obesity and chronic kidney disease was higher post-donation compared to the general population, indicating the need for structured long-term monitoring.