Pre‐ and postdonation kidney function in donors of a kidney paired donation with unique criteria for donor glomerular filtration rate – a longitudinal cohort analysis

Summary Baseline predonation estimated GFR ( eGFR ) appears to predict the risk of postdonation chronic kidney disease in live donors. New KIDGO guidelines recommend an eGFR ≥90 ml/min/1.73 m 2 as an acceptable level of glomerular filtration rate ( GFR ) for kidney donation. In the Australian Paired Kidney Exchange ( AKX ) program, all donors with a raw measured GFR ( mGFR ) ≥80 ml/min are deemed suitable for donation, but the significance of this selection indicator is unclear. We analysed the first 129 live donors in the AKX program with at least 1‐year follow‐up linking records in the AKX database and ANZDATA . There were 73 male and 56 female donors; mean (± SD ) age was 53 ± 11 years. Predonation eGFR was 94 ± 13 ml/min/1.73 m 2 , mGFR 99 ± 17 ml/min/1.73 m 2 and raw mGFR 108 ± 18 ml/min. Baseline eGFR was <80 ml/min/1.73 m 2 in 19 donors, and <90 ml/min/1.73 m 2 in 42 donors. At 1 year postdonation eGFR was 68 ± 15 ml/min/1.73 m 2 and the predicted eGFR at 30 years postdonation was on average 50 (29–83) ml/min/1.73 m 2 . The hypothetical mean age at end‐stage kidney disease was estimated to be 145 (95% CI 120–263) years. Over 30% of AKX live donors would have been excluded from donation using KDIGO guidelines. Using AKX donor guidelines, the majority of donors with predicted eGFR <30 ml/min/1.73 m 2 30‐year postdonation were aged ≥50 years. Long‐term outcome data on AKX donors with low eGFR will need careful monitoring.