Background: Chronic organ shortage remains a pressing issue in South Korea, where the deceased donation rate remains low and donation after circulatory death is not yet implemented. As a result, living kidney donation continues to play a central role in transplantation. In this context, understanding how donor characteristics and post-donation follow-up have changed over time is essential for safeguarding donor health and informing future policy.
Methods: We retrospectively reviewed data from 2,023 living kidney donors who underwent nephrectomy at Severance Hospital, Seoul, South Korea, between January 2006 and June 2023. Donor characteristics—including age, hypertension, diabetes mellitus, and body mass index—were analyzed in 3-year intervals. Additionally, we assessed 1-year follow-up adherence and renal function across time periods.
Results: The mean donor age increased from 40.6 years (2006–2008) to 49.2 years (2021–2023). The prevalence of hypertension increased significantly, rising from 5.4% to 17.7% across the study period, while diabetes mellitus remained consistently rare (<1%). Body mass index showed a mild increase from 23.3 to 23.9 kg/m². Importantly, mean 1-year estimated glomerular filtration rates remained above 70 mL/min/1.73m² in all time intervals, supporting short-term renal safety. Follow-up adherence improved significantly: 1-year follow-up rates increased from 57.9% (2006–2008) to 90.5% (2021–2023). These findings highlight both the evolving risk profile of living donors and institutional efforts to improve long-term donor monitoring.
Conclusion: Over the past two decades, living kidney donors have become older and more comorbid, especially with respect to hypertension. Nonetheless, 1-year renal outcomes remained favorable, and follow-up adherence markedly improved. These results underscore the need for robust, longitudinal donor surveillance systems and updated risk stratification frameworks that reflect shifting demographics, particularly in regions where living donation predominates.