Clinical Outcomes, Risk Communication, and Follow-Up After Living Kidney Donation: A Retrospective Observational Cohort Study

Background/Objectives: Living kidney donation expands access to transplantation, but donor safety requires effective risk communication and sustained surveillance. We evaluated renal and cardiometabolic changes after donation in conjunction with donor-reported risk communication and follow-up. Methods: This observational cohort study included 91 living kidney donors with paired assessments before donation and 16–18 months after nephrectomy; the analytic cohort included only donors for whom both paired clinical assessments were available. Outcomes included serum creatinine, estimated glomerular filtration rate (eGFR), weight, body mass index (BMI), and blood pressure; counseling and follow-up were assessed retrospectively using a structured questionnaire of donor-reported recall, administered at the post-donation assessment. Changes were summarized as median paired changes with interquartile ranges for non-normally distributed outcomes and as mean paired changes with t-based 95% confidence intervals for normally distributed outcomes; the multiplicity of the six paired comparisons was addressed using a conservative Bonferroni-adjusted significance threshold (0.05/6 = 0.0083). Results: Serum creatinine increased by a median of 0.24 mg/dL, and eGFR had a mean paired change of −22.49 mL/min/1.73 m2 (95% CI −23.16 to −21.83; t(90) = −67.265; p < 0.001). Weight (median +5.0 kg), BMI (median +1.4 kg/m2), systolic blood pressure (median +4.0 mmHg), and diastolic blood pressure (mean +5.68 mmHg) also increased (all p < 0.001; significant under the Bonferroni threshold). No donor had an eGFR < 60 mL/min/1.73 m2 at follow-up. Only 15.4% considered long-term complications adequate, 6.6% recalled counseling regarding future chronic kidney disease or end-stage renal disease, and 19.8% reported regular nephrology follow-up. Conclusions: Although reduced eGFR is an expected physiological consequence of nephrectomy, concurrent increases in weight and blood pressure observed during follow-up warrant surveillance. Donor-reported gaps in recall of risk communication and in reported follow-up support standardized informed consent, individualized counseling, verification of understanding, and structured long-term multidisciplinary care to strengthen donor safety and continuity across transplant programs, nephrology, and primary care services; because the design was observational, without a non-donor comparator, and counseling outcomes were based on donor recall, these findings should be interpreted as associations and reported care gaps rather than evidence of causation.