Long-Term Outcomes of Living-Related Kidney Donors Over 26 Years: A Study of 154 Cases From the Ibn Sina University Hospital Center in Rabat, Morocco.

Introduction Kidney transplantation remains the treatment of choice for end-stage kidney disease (ESKD) because of its excellent outcomes in terms of both graft and recipient survival. However, preserving the long-term health of living kidney donors represents a major challenge in nephrology. Rigorous post-donation follow-up is essential for the early detection of potential renal and cardiovascular complications and for ensuring donor safety. Methods We conducted a retrospective, descriptive, and analytical study over a 26-year period (1998-2024) at the Ibn Sina University Hospital Center in Rabat, Morocco. The study included all living-related kidney donors (LRKD) who underwent nephrectomy for kidney donation according to the Kidney Disease: Improving Global Outcomes (KDIGO) eligibility criteria. The primary objective was to evaluate the incidence of chronic kidney disease (CKD) after donation. Secondary objectives included the assessment of cardiovascular complications, particularly hypertension, and the identification of associated risk factors. Estimated glomerular filtration rate (eGFR) was used to monitor renal function over time. Quantitative variables were expressed as mean±standard deviation, while qualitative variables were presented as frequencies and percentages. Univariate and multivariate analyses were performed, with statistical significance set at p<0.05. Results A total of 154 LRKD were included, with a mean age of 43±12 years and a predominance of female donors (male-to-female ratio: 0.45). During follow-up, infectious complications were the most frequently observed adverse events, affecting 38 donors (24.6%), with recurrent urinary tract infections being the predominant manifestation, reported in 17 donors (11%). In addition, hypertension was diagnosed in 17 donors (11%), while CKD developed in eight donors (5.2%) A decline in eGFR below 60 mL/min/1.73 m² was observed in eight donors (5.2%), with no progression to ESKD. The mean serum creatinine at 20 years of follow-up was 82.3±18.56 µmol/L. Multivariate analysis identified advanced age, male sex, and baseline eGFR as significant predictors of post-donation CKD (p<0.001), whereas no factor was significantly associated with the occurrence of hypertension. In addition, six full-term pregnancies were reported among female donors, without maternal or fetal complications. Conclusion Our findings highlight the importance of rigorous and long-term medical follow-up in LRKD in order to anticipate late complications. Particular attention should be paid to male donors, who appear to be at higher risk of developing renal impairment. Post-donation follow-up should be individualized to ensure optimal management and preserve donor health over time.