Kidney Week

Abstract: FR-PO1143

Phenotypes of Donor eGFR Trajectories in Living Donor Kidney Transplantation: A Nationwide Prospective Cohort Study

Session Information

• Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Lee, Yu ho, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Yu ho Lee, MD, PhD

• Lee, Jeong-Yeun, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Jeong-Yeun Lee, MD

• Yoon, Soo-Young, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Soo-Young Yoon, MD, PhD

• Kim, Jinsug, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Jinsug Kim, MD

• Jeong, Kyunghwan, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Kyunghwan Jeong, MD, PhD

• Hwang, Hyeon Seok, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Hyeon Seok Hwang, MD, PhD

Background

Post-donation kidney function varies considerably among living kidney donors. However, longitudinal patterns of estimated glomerular filtration rate (eGFR) after nephrectomy and their clinical implications remain incompletely characterized.

Methods

We analyzed data from 5,510 living kidney donors and their matched recipients enrolled in a nationwide prospective cohort. Longitudinal post-donation eGFR measurements were used to identify donor trajectory classes. Donor characteristics and matched recipient graft outcomes were evaluated across donor eGFR trajectory phenotypes.

Results

Four distinct donor eGFR trajectory classes were identified: class 1 (stable, 84.2%), class 2 (higher initial values followed by mild decline and recovery, 10.8%), class 3 (gradual and sustained increase, 3.9%), and class 4 (rapid early increase followed by a rapid decline, 1.1%). Younger donor age and higher baseline eGFR were independently associated with class 4 compared with class 1. Class 4 donors showed higher cumulative incidence of post-donation kidney dysfunction, including ≥50% eGFR decline and eGFR <45 ml/min/1.73 m. Recipients of class 4 donors had higher risks of death-censored and all-cause graft loss than those of class 1 donors (adjusted hazard ratio [95% confidence interval] of 2.63 [1.14–6.06], and 3.30 [1.72–6.34], respectively).

Conclusion

Living kidney donors exhibit heterogeneous eGFR trajectories after nephrectomy. A high-risk trajectory with a rapid early increase followed by a rapid decline was associated with adverse post-donation kidney outcomes of the donors and a higher risk of graft loss in matched recipients.