Twenty-One Years of Insights From A Single-Center Living Kidney Donation Program.

Kidney transplantation provides superior survival, quality of life, and cost-effectiveness compared with dialysis. Living donor kidney transplantation further improves outcomes by reducing waiting times and increasing access. We report a 21-year single-center retrospective analysis of the LDKT program at ULS São João, including 120 transplants performed between 2004 and 2024. Donor and recipient demographic, clinical, and immunological characteristics and post-transplant outcomes were reviewed. Primary endpoints were patient and graft survival at 1, 3, 5, 10, 15, and 20 years; secondary outcomes included renal function, rejection episodes, and major complications. Recipients had a mean age of 43.2 ± 9.9 years, 70% male, and 18.3% underwent preemptive transplantation. Donors had a mean age of 47.1 ± 9.1 years and 76.7% were female. Seven primary graft failures occurred. The 1-year acute rejection rate was 11.5%. Median recipient eGFR at last follow-up was 60.1 mL/min/1.73 m². Graft survival was 99.1% at 1, 3, and 5 years, 92.3% at 10 years, and 83.9% at 15 and 20 years; patient survival was 100% at 1 and 3 years and 98.6% thereafter. Donors maintained stable long-term renal function. This experience confirms LDKT as a safe, effective, and durable therapy for end-stage kidney disease and supports expanding living donation in Portugal.