대한신장학회

논문분류	춘계학술대회 초록집
제목	Phenotypes of Donor eGFR Trajectories and Graft Outcomes in Living Donor Kidney Transplantation: A Nationwide Prospective Cohort Study
저자	Yu Ho Lee
출판정보	2026; 2026(1):
키워드	kidney transplantation, living kidney donor, estimated glomerular filtration rate, kidney function trajectory, graft loss
초록	Objectives: Post-donation kidney function varies considerably among living kidney donors, yet longitudinal patterns of estimated glomerular filtration rate after nephrectomy and their potential clinical implications remain incompletely characterized. This study aimed to identify distinct post-donation estimated glomerular filtration rate (eGFR) trajectory patterns in living donors and to evaluate their associations with graft outcomes in matched recipients. Methods: We analyzed data from 5510 living kidney donors and their corresponding recipients enrolled in a nationwide prospective cohort. Longitudinal post-donation eGFR measurements were used to identify donor trajectory classes using latent class mixed modeling. Donor characteristics associated with each trajectory were evaluated, and recipient graft outcomes were compared based on matched donor class. Results: Four distinct donor eGFR trajectory classes were identified: class 1 (stable, 84.2%), class 2 (higher initial values followed by mild decline and recovery, 10.8%), class 3 (gradual and sustained increase, 3.9%), and class 4 (rapid early increase followed by a rapid decline, 1.1%). Younger donor age and higher baseline eGFR were independently associated with class 4 compared with class 1. Recipients of class 4 donors had higher risks of death-censored and all-cause graft loss than those of class 1 donors (adjusted hazard ratio [95% confidence interval] of 2.63 [1.14–6.06], and 3.30 [1.72–6.34], respectively). The predicted probability of class 4 membership was positively correlated with the risk of death-censored graft loss in matched recipients. Conclusion: Living kidney donors exhibit heterogeneous eGFR trajectories after nephrectomy. A trajectory characterized by a rapid early increase followed by a rapid decline in kidney function is associated with adverse graft outcomes in matched recipients. Recognition of high-risk donor trajectories may support individualized post-donation monitoring strategies and enhance the long-term safety of living kidney donation.
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