Donor Risk Factors Research Articles

(821) - Donor and Recipient Risk Factors for Early Airway Dehiscence Following Lung Transplantation

(821) - Donor and Recipient Risk Factors for Early Airway Dehiscence Following Lung Transplantation

Long-Term Outcomes of Kidney Transplantation From Expanded Criteria Deceased Donors at a Single Center: Comparison With Standard Criteria Deceased Donors

Our objective was to compare the clinical outcomes of adult kidney transplants from expanded criteria deceased donors (ECD) with those from concurrent standard criteria deceased donors (SCD). Between January 2000 and December 2011, we transplanted 195 deceased donor renal transplants into adult recipients, including 31 grafts (15.9%) from ECDs and 164 grafts (84.1%) from SCDs. ECDs were classified using the United Network for Organ Sharing (UNOS) definitions. Donor and recipient risk factors were analyzed separately and their correlation with recipient graft function and survival was evaluated (minimum 6-month follow-up). ECDs were older (56.8 ± 6.3 years), showed an increased incidence of hypertension, diabetes, and cerebrovascular brain death, and had a higher preretrieval serum creatinine level than SCDs. ECD kidney recipients had a shorter waiting time (P = .019) but other baseline characteristics (age, gender, body mass index [BMI], cause of end-stage renal disease, type of renal replacement therapy, incidence of diabetes and hypertension, number of HLA antigen mismatches, positivity for panel-reactive antigen, and cold ischemic time) were not significantly different from those of SCD kidney recipients. Mean glomerular filtration rate (GFR) at 1 month, 6 months, 1 year, and 3 years after transplantation was significantly lower in recipients of ECD transplants than recipients of SCD transplants, but the GFR level at 5 and 10 years was not significantly different between ECD and SCD recipient groups (P = .134 and .702, respectively). Incidence of acute rejection episodes and surgical complications did not differ significantly between the 2 recipient groups, but the incidence of delayed graft function (DGF) and infectious complications was higher in ECD kidney recipients than SCD kidney recipients (P = .007 and P = .008, respectively). Actual patient and graft survival rates were similar between the 2 recipient groups with a mean follow-up of 43 months. There were no significant differences in graft survival (P = .111) or patient survival (P = .562) between the 2 groups. Although intermediate-term renal function followed longitudinally was better in SCD kidney recipients, graft and patient survival of ECD kidney recipients were comparable with those of SCD kidney recipients. In conclusion, use of renal grafts from ECDs is a feasible approach to address the critical organ shortage.

Microsporidiosis acquired through solid organ transplantation: a public health investigation.

Encephalitozoon cuniculi, a microsporidial species most commonly recognized as a cause of renal, respiratory, and central nervous system infections in immunosuppressed patients, was identified as the cause of a temporally associated cluster of febrile illness among 3 solid organ transplant recipients from a common donor. To confirm the source of the illness, assess donor and recipient risk factors, and provide therapy recommendations for ill recipients. Public health investigation. Two transplant hospitals and community interview with the deceased donor's family. Three transplant recipients and the organ donor. Specimens were tested for microsporidia by using culture, immunofluorescent antibody, polymerase chain reaction,immunohistochemistry, and electron microscopy. Donor medical records were reviewed and a questionnaire was developed to assess for microsporidial infection. Kidneys and lungs were procured from the deceased donor and transplanted to 3 recipients who became ill with fever 7 to 10 weeks after the transplant. Results of urine culture, serologic,and polymerase chain reaction testing were positive for E. cuniculi of genotype III in each recipient; the organism was also identified in biopsy or autopsy specimens in all recipients. The donor had positive serologic test results for E. cuniculi. Surviving recipients received albendazole. Donor assessment did not identify factors for suspected E. cuniculi infection. Inability to detect organism by culture or polymerase chain reaction in donor due to lack of autopsy specimens. Microsporidiosis is now recognized as an emerging transplant-associated disease and should be considered in febrile transplant recipients when tests for routinely encountered agents are unrevealing. Donor-derived disease is critical to assess when multiple recipients from a common donor are ill.

Gene expression profile in delay graft function: inflammatory markers are associated with recipient and donor risk factors.

Background. Delayed graft function (DGF) remains an important problem after kidney transplantation and reduced long-term graft survival of the transplanted organ. The aim of the present study was to determine if the development of DGF was associated with a specific pattern of inflammatory gene expression in expanded criteria of deceased donor kidney transplantation. Also, we explored the presence of correlations between DGF risk factors and the profile that was found. Methods. Seven days after kidney transplant, a cDNA microarray was performed on biopsies of graft from patients with and without DGF. Data was confirmed by real-time PCR. Correlations were performed between inflammatory gene expression and clinical risk factors. Results. From a total of 84 genes analyzed, 58 genes were upregulated while only 1 gene was downregulated in patients with DGF compared with no DGF (P = 0.01). The most relevant genes fold changes observed was IFNA1, IL-10, IL-1F7, IL-1R1, HMOX-1, and TGF-β. The results were confirmed for IFNA1, IL-1R1, HMOX-1 and TGF-β. A correlation was observed between TGF-β, donor age, and preablation creatinine, but not body mass index (BMI). Also, TGF-β showed an association with recipient age, while IFNA1 correlated with recipient BMI. Furthermore, TGF-β, IFNA1 and HMOX-1 correlated with several posttransplant kidney function markers, such as diuresis, ultrasound Doppler, and glycemia. Conclusions. Overall, the present study shows that DGF is associated with inflammatory markers, which are correlated with donor and recipient DGF risk factors.

Early allograft dysfunction: Causes, recognition, and management

Early allograft dysfunction: Causes, recognition, and management

Can donors with high donor risk indices be used cost-effectively in liver transplantation in US Transplant Centers?

In an effort to quantify the impact of donor risk factors on recipient outcomes, the donor risk index (DRI) was developed. A high DRI correlates with poorer post-transplant survival. In this study, high-DRI donors are classified as those having DRIs >2.0, while low-DRI donors have DRIs <2.0. The aim of this study was to evaluate the cost-effectiveness of high-DRI donor use in US Transplant Centers. A Markov-based decision analytic model was created to simulate outcomes for an allocation scheme using only low-DRI donors versus a scheme using both low- and high-DRI donors. Baseline values and ranges were determined from published data and Medicare cost data. Sensitivity analyses were conducted to test model strength and parameter variability. An allocation scheme in which only low-DRI donors were used generated 5.2 quality-adjusted life years (QALYs) at a cost of $83000/QALY. An allocation scheme using both low- and high-DRI donors generated 5.9 QALYs at a cost of $66000/QALY. Sensitivity analyses supported the use of an allocation scheme using both low- and high-DRI donors. The overall contribution of high-DRI grafts to the donor pool and the resultant reduction in wait-list mortality make them cost-effective.

Donors' characteristics and impact on outcomes in pediatric heart transplant recipients

Organ availability and acceptability limit pediatric HTx. What characteristics define an unacceptable or high-risk pediatric donor remains unclear. The purpose of this study was to characterize a large cohort of pediatric donors and determine the donor risk factors, including cumulative risk, that affect recipient survival. Data from the PHTS, a prospective multicenter study, were used to examine the impact of donor factors on the outcomes of patients listed <18yr of age who received a HTx between 1993 and 2009. Donor data were available for 3149 of 3156 HTx (99.8%). Donor cause of death, need for inotropes, or CPR did not affect survival outcomes (p=0.05). Ischemic time also did not have an impact on overall recipient survival; however, longer ischemic times negatively impacted one-yr post-transplant survival (p<0.0001). There was no impact of cumulative risk factors on survival (p=0.8). Although used in a minority of cases, hormonal therapy in the donor positively impacted survival (p=0.03). In multivariate analysis, the only donor factor associated with decreased survival was smaller donor BSA, the other factors being related to the recipient characteristics. When analyzed by recipient age, there were no donor-related factors that affected survival for those who received a transplant at <6months of age. Longer ischemic time (p<0.0001) and greater age difference between the recipient and donor (p=0.0098) were donor-related factors impacting early-phase survival for recipients who received a graft at ≥10yr of age. Factors perceived to define a marginal or high-risk pediatric heart donor including inotrope use, CPR and donor cause of death may have less impact on outcomes than previously thought. Longer ischemic times did impact oneyr, but not overall survival, and this impact was much greater with older donors. Parameters for accepting a donor heart can potentially be expanded, especially in the infant age group, but strong consideration should always be given to the interaction between ischemic time and donor age.

Hypertension after Kidney Transplantation: A Pathophysiologic Approach

Post-transplant hypertension is associated with decreased graft and patient survival and cardiovascular morbidity. Unfortunately, post-transplant hypertension is often poorly controlled. Important risk factors include immunosuppressive medications, complications of the transplant surgery, delayed graft function, rejection, and donor and recipient risk factors. The effects of immunosuppressive medications are multifactorial including increased vascular and sympathetic tone and salt and fluid retention. The immunosuppressive agents most commonly associated with hypertension are glucocorticoids and calcineurin inhibitors. Drug therapy for hypertension should be based on the comorbidities and pathophysiology. Evidence-based approaches to defining and treating hypertension in renal transplant recipients are predominantly extrapolated from large-scale studies performed in the general population. Thus, there continues to be a need for larger studies examining the pathophysiology, diagnosis and treatment of hypertension in renal transplant recipients.

Who Fares Worse After Liver Transplantation? Impact of Donor and Recipient Variables on Outcome

Numerous donor and recipient risk factors influence survival after liver transplantation (LT). The aim of this study was to prospectively evaluate the effect of donor and recipient variables on 12-month patient and graft survival after LT. Five hundred forty-six patients underwent LT in a single center (2000-2010). Bilirubin (P=0.006) and cold ischemia time (P=0.002) were predictive of graft loss at 12 months after LT. Model for End-Stage Liver Disease score ≥25 was associated with a lower 12-month graft survival than Model for End-Stage Liver Disease score <15 (P=0.02). Hepatitis C virus (HCV)-positive patients showed a lower survival than HCV-negative patients 12 months after LT (P=0.04), with serum sodium concentration (P=0.01) predictive for graft survival. Donor age demonstrated a trend of prediction (P=0.05) for HCV-positive patient survival. In hepatocellular carcinoma patients, donor age (P=0.02 and 0.02) and use of partial graft (P=0.01 and 0.02) were predictive of patient and graft survival at 12 months after LT. Bilirubin and cold ischemia time are crucial for graft outcome post-LT. Survival in HCV-positive patients is lower than in HCV-negative recipients. Donor age and partial graft use are predictive of patient and graft survival in hepatocellular carcinoma patients.

Donor Factors Predictive for Poor Outcomes of Living Donor Kidney Transplantation

IntroductionThe aim of this study was to explore donor risk factors that predict the poor outcomes after living donor kidney transplantation. MethodsWe retrospectively analyzed our 219 living donor kidney transplantations collecting donor age and gender, graft glomeular filtration rate (GFR), human leukocyte antigen (HLA) typing, recipient age and gender, acute rejection episodes chronic rejection, and 1-year serum creatinine level. Patient and graft survivals were calculated using the Kaplan-Meier analysis. Independent donor risk factors affecting graft survival and 1-year serum creatinine level were analyzed using Cox regression and logistic regression. ResultsOne-, 3-, 5-year patient and graft survivals were 98.6%, 98.1%, and 97.4% and 97.7%, 95.0%, and 92.2%, respectively. Acute rejection rate was 12.8%, and chronic rejection, 4.1%. If donor age was over 50 years, there were significantly increased incidences of acute and chronic rejection (χ2 were 5.385 and 5.039; P < .05). Univariate analysis showed donor age > 50 years, graft GFR < 35 mL/min, female to male, HLA mismatch > 3 loci to be risk factors for an abnormal 1-year serum creatinine. Logistic multivariate regression revealed donor age > 50 years, female to male, and graft GFR before transplant < 35 mL/min to be independent risk factors for an abnormal 1-year serum creatinine level (odds ratio values 5.928, 2.489, and 6.993, respectively; P < .05). Cox multivariate regression demonstrated that graft GFR before transplant < 35 mL/min was an independent risk factor for long-term graft survival (relative risk value = 6.984; P = .004). ConclusionOlder donor, female to male, and insufficient graft GFR before transplantation are predictive factors for poor outcomes of living donor kidney transplantations.

Normothermic Ex Vivo Lung Perfusion as an Assessment of Marginal Donor Lungs – The NOVEL Lung Trial

Purpose Sponsor: XVIVO Perfusion, Goteborg Sweden. Completion date of the trial: April 2013. Methods and Materials This report will describe the first prospective and multicenter clinical trial using ex vivo lung perfusion (EVLP) as a mean to identify “good” grafts from the substandard donor pool. The main goal of this trial is to define EVLP safety by comparing results between ex vivo evaluated and standard criteria lungs. The trial hypothesis is that the ex vivo selected lungs will have equivalent post-transplant outcomes to standard criteria lungs. Results This is a phase 1, prospective, non-randomized, and multicenter clinical trial (six U.S. centers). Recruitment is set to stop once 42 transplants after ex vivo lung evaluation (study arm) have been included and matched to 42 contemporary transplants using standard criteria lungs (control arm). To this date, 28 transplants after ex vivo evaluation and 28 using standard criteria donors have been included. Donor inclusion criteria (EVLP arm): At the time of the clinical evaluation, the PaO2/FiO2 ≤ 300mmHg; If PaO2/FiO2 > 300mmHg and the donor has any one or more of the following donor risk factors: – Multiple blood transfusions. – Pulmonary edema detected via CXR, bronchoscopy or palpation of lungs. – Donation after cardiac death donors. – Investigator evaluation of donor lung as “unsuitable” for standard criteria for lung transplant. – Donor exclusion criteria: – Donor lung has pneumonia and/or persistent purulent secretions on bronchoscopy. – Donor has aspirated gastric contents in to the lung. – Donor lung has significant mechanical lung injury or trauma. – Donor lung has active infectious disease such as HIV, Hepatitis B or C, HTLV or Syphilis. Conclusions 30 day mortality. Secondary outcomes: – PGD scores at 0, 24 and 72 hours. – Length of ICU stay post transplant. – Ventilator status and extra-corporeal membrane oxygenator status 7 days after transplant. – 12-month subject’s survival status.

Impact of Donor-Recipient Sex Matchup on Survival after Heart Transplantation in Children: An Analysis of >6000 Pediatric Heart Transplants

Purpose Studies in adults suggest a difference in survival based on sex matchup between donor and recipient. However, no such data exist for children whose recipient and donor risk factors can be quite different from adults. We sought to examine the effect of sex matchup on outcome in children using the Scientific Registry of Transplant Recipients. Methods and Materials We examined 6077 pediatric heart transplant donor-recipient (age ≤ 18 yrs) data entries from the Registry between 1987-2011. Recipients were stratified into 4 groups: donor male, recipient male (MM, n=1987); donor female, recipient male (FM, n=1447); donor female, recipient female (FF, n=1132); donor male, recipient female (MF, n=1511). The primary outcome endpoint was a composite of all-cause mortality or retransplantation. Results MM patients had the best outcome overall (93% at 30 days, 85.7% at 1 year, 72.1% at 5 years), and the MF group had the worst (90.5, 81.9%, 66.8%). The MM group had a survival advantage compared to FM (91.0%, 82.5%, 69.6%), which became statistically significant after 5 years by log-rank test (p = 0.02), and approached significance (p=0.12) when adjusted for recipient age and primary diagnosis (cardiomyopathy, congenital heart disease or other) by Cox proportional hazard regression. The FF (91.3%, 82.2%, 70.1%) to MF comparison was not statistically significant. [ figure 1 ] Conclusions Male pediatric recipients have improved long term survival when they receive a sex-matched heart, consistent with the survival pattern seen in adult recipients. No survival advantage was seen for female recipients receiving a sex-matched heart.

Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

Purpose Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies of PGD risk factors have produced conflicting results due to small sample sizes, inconsistencies in PGD phenotype, inability to control for multiple confounders, and use of retrospective, single center, or administrative data. We sought to identify donor, recipient, and peri-operative risk factors for PGD. Methods and Materials We performed a 10 center prospective cohort study enrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was grade 3 PGD at 48 or 72 hrs post transplant. The association of risk factors with PGD was analyzed using multivariable conditional logistic regression. Results 1255 patients were enrolled; 211 subjects (16.8%) developed PGD. In multivariable models, risk factors for PGD were any history of donor smoking (OR=1.8, 95%CI 1.2, 2.6, p=0.002), FiO2 at allograft reperfusion (OR=1.1 per 10% increase in FiO2, 95%CI 1.0, 1.2; p=0.01), single lung transplant (OR=2.0, 95%CI 1.2, 3.3; p=0.008), cardiopulmonary bypass (OR=3.4, 95%CI 2.2, 5.3; p Conclusions We identified important PGD risk factors, including donor smoking, recipient factors of pre-transplant diagnosis and BMI, and perioperative treatment variables, including use of cardiopulmonary bypass, blood transfusion volume, and FiO2 at reperfusion. Several of these risk factors are potentially modifiable, and thus may suggest preventative strategies, while other risk factors should be prioritized for future mechanistic research efforts.

Deceased donor risk factors influencing liver transplant outcome

As the pressure for providing liver transplantation to more and more candidates increases, transplant programs have begun to consider deceased donor characteristics that were previously considered unacceptable. With this trend, attention has focused on better defining those donor factors that can impact the outcome of liver transplantation. This review examines deceased donor factors that have been associated with patient or graft survival as well as delayed graft function and other liver transplant results.

Donor risk factors, retrieval technique, preservation and ischemia/reperfusion injury in pancreas transplantation

Pancreas transplantation is still hampered by a high incidence of early graft loss, and organ quality concerns result in high nonrecovery/discard rates. Demographic donor characteristics, surgical retrieval strategy, preservation fluid and ischemia time are crucial factors in the process of organ selection and are discussed in this review. The donor shortage is driving an increasing utilization of nonideal organs which would previously have been identified as unsuitable. Recent literature suggests that organs from extended criteria donors - older (>45 years), BMI >30 kg/m(2), and donation after cardiac death (DCD) - can achieve the same graft and patient survival as those from standard criteria donors, with the proviso that the accumulation of risk factors and long ischemic times should be avoided. Visual assessment of the pancreas is advisable before declining/accepting a pancreas. University of Wisconsin represents the gold standard solution; however, histidine-tryptophan-ketoglutarate and Celsior result in equal outcomes if cold ischemia time (CIT) is less than 12 h. Currently in pancreas transplantation, there is no proven effective ischemia/reperfusion injury prophylaxis than trying to keep CIT as short as possible. Demographic risk factors, inspection of the pancreas by an experienced surgeon and predicted CIT are crucial factors in deciding whether to accept a pancreas for transplantation. However, there is a need for an improved evidence base to determine where to set the 'cut-off' for unsuitable pancreatic grafts.

Evaluation of risk factors for cytomegalovirus infection and disease occurring within 1 year of liver transplantation in high‐risk patients

Recent studies have demonstrated that cytomegalovirus (CMV) infection and disease are associated with increased risk of graft loss and death in high-risk (donor CMV seropositive/recipient CMV seronegative) liver transplant recipients (LTR) despite effective antiviral chemoprophylaxis. Predictors of CMV infection and disease in this important population are incompletely defined. A retrospective cohort study of 227 high-risk first LTR who received primary anti-CMV chemoprophylaxis during the first 100days after transplant was performed. A large number of patient, donor, operative, and post-transplant potential risk factors were collected. Associations of potential risk factors for CMV infection or disease that occurred during the first year after transplant were assessed using Cox regression models. After Bonferroni adjustment for multiple testing, P-values ≤0.00125 (associations with CMV infection) and ≤0.00122 (associations with CMV disease) were considered as statistically significant. CMV infection and disease occurred in 91 (40%) and 43 (19%) of LTR, respectively. In multivariable analysis, increased risk of CMV infection was observed for patients with lower model for end-stage liver disease (MELD) score (P=0.025), lower total bilirubin (P=0.014), and longer operative time (P=0.038), whereas increased risk of CMV disease was seen in patients with lower MELD score (P=0.026), lower total bilirubin (P=0.044), and lower international normalized ratio (P=0.043). However, after adjustment for multiple testing, none of these findings approached statistical significance. Our results suggest that interventions designed to prevent CMV infection and disease should be applied to all high-risk LTR until more definitive predictors of these complications are identified.

Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors. We sought to identify donor, recipient, and perioperative risk factors for PGD. We performed a 10-center prospective cohort study enrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was International Society for Heart and Lung Transplantation grade 3 PGD at 48 or 72 hours post-transplant. The association of potential risk factors with PGD was analyzed using multivariable conditional logistic regression. A total of 1,255 patients from 10 centers were enrolled; 211 subjects (16.8%) developed grade 3 PGD. In multivariable models, independent risk factors for PGD were any history of donor smoking (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.6; P = 0.002); FiO2 during allograft reperfusion (OR, 1.1 per 10% increase in FiO2; 95% CI, 1.0-1.2; P = 0.01); single lung transplant (OR, 2; 95% CI, 1.2-3.3; P = 0.008); use of cardiopulmonary bypass (OR, 3.4; 95% CI, 2.2-5.3; P < 0.001); overweight (OR, 1.8; 95% CI, 1.2-2.7; P = 0.01) and obese (OR, 2.3; 95% CI, 1.3-3.9; P = 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1-5.6; P = 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6-7.7; P = 0.002); and mean pulmonary artery pressure (OR, 1.3 per 10 mm Hg increase; 95% CI, 1.1-1.5; P < 0.001). PGD was significantly associated with 90-day (relative risk, 4.8; absolute risk increase, 18%; P < 0.001) and 1-year (relative risk, 3; absolute risk increase, 23%; P < 0.001) mortality. We identified grade 3 PGD risk factors, several of which are potentially modifiable and should be prioritized for future research aimed at preventative strategies. Clinical trial registered with www.clinicaltrials.gov (NCT 00552357).

Liver Transplantation Outcome in Patients With Angiographically Proven Coronary Artery Disease: A Multi-Institutional Study

Over the last decade the age of liver transplant (LT) recipients and the likelihood of coronary artery disease (CAD) in this population have increased. There are no multicenter studies that have examined the impact of CAD on LT outcomes. In this historical cohort study, we identified adult LT recipients who underwent angiography prior to transplantation at seven institutions over a 12-year period. For each patient we recorded demographic data, recipient and donor risk factors, duration of follow-up, the presence of angiographically proven obstructive CAD (≥50% stenosis) and post-LT survival. Obstructive CAD was present in 151 of 630 patients, the CAD(+) group. Nonobstructive CAD was found in 479 patients, the CAD(-) group. Patient survival was similar for the CAD(+) group (adjusted HR 1.13, CI = [0.79, 1.62], p = 0.493) compared to the CAD(-) group. The CAD(+) patients were further stratified into severe (CADsev, >70% stenosis, n = 96), and moderate CAD (CADmod, 50-70% stenosis, n = 55) groups. Survival for the CADsev (adjusted HR = 1.26, CI = [0.83, 1.91], p = 0.277) and CADmod (adjusted HR = 0.93, CI = [0.52, 1.66], p = 0.797) groups were similar to the CAD(-) group. We conclude that when current CAD treatment strategies are employed prior to transplant, post-LT survival is not significantly different between patients with and without obstructive CAD.

Selection of induction therapy in kidney transplantation

Currently available immunosuppressive agents can be classified into three categories: induction agents, maintenance therapy, and treatment for rejection. This review article will focus on induction immunosuppression. There are three antibodies which are used for induction therapy: the lymphocyte-depleting agents - anti-thymocyte globulin and alemtuzumab, and basiliximab which is nondepleting. Historically, immunosuppressant selection was solely based on efficacy for prevention of rejection. In the current era of transplantation, it is now common practice in the transplant community to select induction therapy on the basis of risk-benefit considerations for each patient. This article will focus on the efficacy of available induction agents and the selection of induction agent based on donor and recipient risk factors.

Effect of Obesity on Renal Function and Cardiovascular Disease Risk Factors in Long-Term Kidney Donors

Introduction: Due to the growing demand for living donor kidneys, previously ineligible patients are being considered for donation. One increasingly used group are obese patients, and despite evidence that obesity increases risk of renal dysfunction and cardiovascular disease (CVD), the long-term consequences of kidney donation in this population remain unknown. We examined whether obese donors are at higher risk for developing renal dysfunction and other CVD risk factors years after donation. Methods: All 1750 patients who donated a kidney at our institute between 1967-2005 were contacted; of these, 219 (mean time since donation 14 7 yrs) agreed to participate. Patients were stratified according to BMI, and BP, lipid panel, serum cystatin C, and presence of Metabolic Syndrome (MS) were determined. Renal function was evaluated with direct (iohexol) as well as indirect (MDRD) Glomerular filtration rate (GFR) measurements and 24-h urine collections for total protein/albumin. Results: Clinical characteristics are listed in the Table. All BMI groups had similar age and racial distribution. There were more men and longer follow-up among obese patients (BMI 30-34.9) but this trend was seen in the entire cohort. We found no association between increasing BMI and GFR or abnormal proteinuria/albuminuria. In contrast, increasing BMI was strongly associated with increased incidence of MS, hyperlipidemia, hypertension and high serum cystatin C after donation. This was confirmed with multivariate analysis which also demonstrated that increasing BMI in female donors was associated with a higher odds ratio of developing MS (2.1 vs. 3.5), hypertension(1.7 vs. 1.5) and high serum cystatin C levels (3.4 vs. 1.3) than in men.Conclusion: On long-term follow-up, obese kidney donors are not at higher risk for renal dysfunction, but do have an increased incidence of several CVD risk factors. This finding is more pronounced among female donors. We conclude that obesity is not a contraindication to donation, but obese donors, particularly female donors, should receive systematic long-term medical follow-up.