Kidney Week

Abstract: FR-OR089

Donation vs. Disease: eGFR-Based Cardiovascular Risk Among Living Kidney Donors vs. Nondonors

Session Information

• The Changing Landscape of Kidney Transplantation: Clinical Innovation, Outcomes, and Health Policy
  October 23, 2026 | Location: Mile High Ballroom 4A, Convention Center
  Abstract Time: 05:40 PM - 05:50 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Husain, Syed Ali, NYU Langone Health, New York, New York, United States

Syed Ali Husain, MD, MA, MPH, FASN

• Terlizzi, Kelly, NYU Langone Health, New York, New York, United States

Kelly Terlizzi, MS

• Mankowski, Michal, NYU Langone Health, New York, New York, United States

Michal Mankowski, PhD

• Levan, Macey L., NYU Langone Health, New York, New York, United States

Macey L. Levan, PhD, JD

• Coresh, Josef, NYU Langone Health, New York, New York, United States

Josef Coresh, MD, PhD, FASN

• Grams, Morgan, NYU Langone Health, New York, New York, United States

Morgan Grams, MD, PhD

• Segev, Dorry L., NYU Langone Health, New York, New York, United States

Dorry L. Segev, MD, PhD

• Massie, Allan, NYU Langone Health, New York, New York, United States

Allan Massie, PhD

Group or Team Name

• Center for Surgical & Transplant Applied Research (CSTAR)

Background

In the general population, low eGFR is associated with higher risk of major adverse cardiovascular events (MACE). Uniquely, living kidney donors (LKDs) have reduced GFR due to donation rather than disease-related nephron loss; whether decreased eGFR confers similar MACE risk in this population is unknown.

Methods

Using Epic Cosmos, a national database of >301M patients, we identified 56,496 LKD with a donation date before 1/1/2023 and 100,000 randomly selected controls. We used time-to-event analyses to determine the risk of MACE by eGFR category among LKD with an available eGFR 2-5 years post-donation, 10-12 years post-donation, and ≥20 years post-donation, as well as among controls. Inpatient eGFR values were excluded.

Results

Median age at donation was 44 years (IQR 34-53), 64% were female, and 63% were White.
Median eGFR in LKDs was 69 (IQR 59-80) 2-5y postdonation, 69 (59-80) 10-12y postdonation, and 68 (57-81) ≥20y postdonation (N=16105, 6325, and 6396 respectively). Lower eGFR was associated with a higher risk of MACE among both LKD and controls at each post-donation time period (Figure 1).

LKD 2-5 years post-donation had a lower MACE risk compared to controls within each eGFR category, and this finding was also true for LKD 10-12 years post-donation vs controls except those with eGFR≥90 (Figure 2). Among LKD≥20 years post-donation, MACE risk was lower than controls among those with eGFR 45-59 and 60-74, and was higher among those with eGFR≥90.

Conclusion

Lower eGFR is associated with higher risk of MACE among both LKD and nondonors. However, LKD have substantially less MACE risk than nondonors with similar eGFR, and though this advantage attenuates over time it remains present through 20 years post-donation for LKD with eGFR in the typical range.

Funding

• NIDDK Support