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As there is a paucity of literature regarding the long term outcomes of complex living donors, we conducted this study to assess the effect of kidney donation on the complex living kidney donor.This was a long term retrospective study conducted at Narayana Health Hospitals, Kolkata, a tertiary care center in Eastern India. 69 kidney donors were included in the study. The kidney donors were 60 years or more of age or if age was lesser than 60 years, they had co-morbidities like Impaired glucose tolerance, hypertension, obesity etc. All donors underwent evaluation of renal function, morbidity by a single OPD visit after at least 5 years of donation. Renal function was evaluated by Serum creatinine estimation and measurement of e- GFR (MDRD). Measurement of urinary albumin was done by 24 hour urinary collection. BSA and BMI was determined by height and weight measurement. Hypertension was labeled when the donor required antihypertensive medication or the blood pressure reading was >149/90mm Hg twice.Data pertaining to Hypertension, New Onset Diabetes, BMI, e-GFR, albuminuria, cardiac events were compared from the time of donation till at least 5 years post-transplant.There were 90 marginal donors during the study period. 69 donors responded to the study. 4 donors died 10 years post donation.62.3% donors had age between 61-70 years, 21.5% between 51 -60 years, 11.6 % from 41-50 years, 1.4% between 31-40, 21-30 and 71- 80 years of age.66.7% donors were women and 33.3% were men.During present assessment 73.9 % donors were hypertensive out of which 30.4% were on single, 34.8% on two and 8.7% on triple antihypertensives. The pre-donation Systolic BP was <120 in 7.2%, 88.4% between 120-139, 4.3% between 140-159. At present, 70.8% donors had SBP ranging from 140 -160, 29.2% in the range of 120 -139 (pre-hypertensive). Pre-donation, 34.8% donors had DBP <80, 56.5 % - 80-89, 8.7% in range of 90-99 mmHg. At present assessment 63.1% had DBP – 90 -99, 30.8 % had DBP – 80-99, and 6.2% < 80 .22.3% donors developed DM post donation. The BMI of 62.3% donors was between 18.5-25, 37.7% - 25 -30. We excluded donors with BMI > 30.A present 81.5% donors have BMI – 25 -30 (overwt), 6.2% have BMI >30, 12.3% - < 25.Although the ever increasing demand for kidney donors has led to the procurement of kidneys from marginal donors, they should be assessed for morbidity / mortality in future as we found a statistically significant deterioration in renal function, Systolic and Diastolic BP in the follow up period.