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Worldwide, tens of thousands of healthy individuals participate in living kidney donation programs to help patients with end-stage renal disease. Potential living donors are exhaustively screened by transplant professionals, who select only those whose health will not be compromised by donation. The past years, single-center and national registry studies on long-term follow-up outcomes comparing donors to non-donors have reported unfavourable results.We conducted a follow-up study of 761 living kidney donors from The Netherlands using individual level donor data who were propensity-score matched with 1522 non-donors from two Western population-based cohort studies on age, gender, BMI, ethnicity, kidney function, blood pressure, pre-existing co-morbidity, smoking, alcohol use and highest education degree. Live kidney donations occurred between 1981 through 2010 with follow-up until April 20th, 2016. All data were obtained from self-reporting, interview-based questionnaires, physical examination, and laboratory tests. The median follow-up time after donation was 8.0 years. The primary outcome was kidney function as defined by creatinine level and eGFR (as measured by CKD-Epi formula) at follow-up.One-year median eGFR was 59.0 ml/min/1.73 m2 (IQR 50.5-68.6 ml/min/1.73 m2) and eGFR at follow-up was 59.9 ml/min/1.73 m2 (IQR 51.4-70.7 ml/min/1.73 m2). Donors were found to have an increased serum creatinine of 26.03 μmol/l (95%CI 24.17; 27.89), a decreased eGFR of 27.23 ml/min/1.73m2 (95%CI -28.61; -25.85), and eGFR decline of 31.70% (95%CI 29.94-33.46) as compared to non-donors at follow-up. There was no difference in outcome between donors and non-donors for ESRD, microalbuminuria, BMI, incidence of diabetes or cardiovascular events, and cardiovascular mortality. A lower risk of new-onset hypertension (OR 0.45, 95%CI 0.33; 0.62) was found among donors. The EQ-5D health-related quality of life was higher among donors, while the SF-12 physical and mental component scores were lower.In conclusion, one year after donation live donors have a reduced renal function, remaining stable without any kidney-related morbidity or mortality to at least eight years of follow-up. However, the decline in renal function may be further compromised when unforeseen conditions would develop that additionally affect renal function. Having knowledge of this risk, albeit small, donors should be well-informed by the medical team and offered lifelong follow-up to monitor the remnant renal function.Nierstichting Nederland. Stichting Coolsingel. Fonds NutsOhra.