Clinical Profiles and Early Outcomes of Living Kidney Donors With Pre‐Existing Type 2 Diabetes
Bonnie E. Lonze, Syed Ali Husain, Jacey B. Newsome, Madhur Thakur, Samantha A. Weiss, Nicole M. Ali, Macey L. Levan, Alvin G. Thomas, Babak J. Orandi, Rhiannon D. Reed, Allan B. Massie, Dorry L. Segev, Darren E. StewartABSTRACT
Introduction
In 2022, Organ Procurement and Transplantation Network policy was revised to permit living kidney donation by carefully selected individuals with type 2 diabetes mellitus (T2DM), which had previously been prohibited. Early evaluation is needed to understand adoption of this practice and short‐term donor outcomes.
Methods
We performed a retrospective cohort study using U.S. national transplant registry data. Living kidney donors with and without pre‐existing T2DM from July 26, 2022 through December 31, 2025 were compared. We examined prevalence, temporal trends, donor characteristics, and early post‐donation outcomes. Five registry‐captured chronic kidney disease risk factors at donation were assessed: insulin dependence, smoking, hypertension, body mass index ≥30 kg/m 2 , and proteinuria.
Results
Among 21,827 donors, 46 (0.21%) had T2DM at donation. T2DM incidence increased from 7 donors in 2022 (0.11%) to 17 (0.26%) in 2025. T2DM donors were older than non‐T2DM donors (median 54y vs. 45y; p < 0.001), and 87% of T2DM donors had ≥1 additional risk factor for CKD. No T2DM donors died, initiated dialysis, or were added to the transplant waiting list. Median most recent eGFR within 2 years was 61 vs. 66 mL/min/1.73m 2 in donors with and without T2DM ( p = 0.20). eGFR <45 mL/min/1.73m 2 , was more frequent in donors with T2DM ( n = 4; 12% vs. n = 596; 4%; p = 0.03) and median 6‐month eGFR‐per‐kidney gain was 11 vs.15 mL/min/1.73m 2 , ( p = 0.12), and proteinuria was present in 12% of T2DM donors vs. 7% ( p = 0.23).
Conclusions
Living kidney donation by individuals with T2DM is uncommon but increasing. Though differences in early outcomes for T2DM vs. non‐T2DM donors were not statistically significant, these null findings are based on small sample sizes and should not be interpreted as evidence of long‐term safety. Careful donor selection and longer‐term follow‐up are needed to better define donor risk.