Prevalence of Obesity After Living Kidney Donation and Its Association with Cardiovascular Risk Factors and Renal Function

Background: Living kidney donor (LKD) transplantation contributes to mitigate the organ shortage and some programs now accept donors with borderline criteria, such as obesity. However, the long-term impact of these criteria extension remains unclear. Methods: This study retrospectively analyzed 306 LKD from 1998 to 2020 to examine obesity trends, predictors, and impact on cardiovascular risk and kidney function. Results: Before donation, 49% of donors were normal weight, 41% were overweight, and 10% were obese. Obese donors were older (50.8 ± 8.8 years, p = 0.009) and had higher rates of dyslipidemia and hypertension (41%, p < 0.001 for both). Over 15 years, obesity rates were stable (8.8-17.4%). A mixed logistic regression model showed that dyslipidemia (OR 6.1, p = 0.042), age (OR 0.9, p=0.005) and body mass index (OR 5.3, p < 0.001) were strong predictors of post-donation obesity. Overweight donors showed an increase in obesity rates over time in the McNemar’s paired analysis [14% obesity by year 3 (p = 0.001); 12.5% at year 10 (p = 0.014)]. Post-donation hypertension was more prevalent in obese donors’ (61.1% vs. 30.4%, p = 0.011), though proteinuria and esti-mated glomerular filtration rate (eGFR) did not differ significantly. Conclusions: These findings show that pre-donation overweight, younger age and dyslipidemia predict post-donation obesity, with hypertension posing added risk for obese donors. There was no impact concerning proteinuria and eGFR. The study un-derscores the importance of careful donor selection and risk informed counseling.