The clinical importance of long-term management and follow-ups is growing in living kidney donors because of increasing life expectancy and marginal donors with metabolic risk factors. Donor nephrectomy may increase the risk of acute kidney injury (AKI) or chronic kidney disease (CKD) due to the absolute reduction of nephron mass especially in living kidney donors with underlying diseases, risk factors, or advanced age. Despite thorough evaluation for determining the possibility of donation and better health status of kidney donors compared to the general population, long term safety concerns still exist in kidney donors regardless of donors’ age because of increased life expectancy and risk factors related with the single kidney status per se and westernized lifestyle that contribute to the development and progression of CKD. The cornerstones regarding safety and follow-up issues in donors would be strategies for reducing the risk of CKD and preventing malignancy. Diabetes mellitus, hypertension, proteinuria, nephrolithiasis, and hyperuricemia are known as important risk factors of CKD. Proper management of these risk factors is critical for accelerating renal adaptation during the immediate postoperative period and preserving renal function as much as possible during donors’ entire life. Appropriate treatment of underlying disease and risk reduction through proactive lifestyle modification as well as avoidance of nephrotoxic agents are key points of long-term managements. Regular checkups and abstaining from smoking are also important for early diagnosis and risk reduction of malignancies especially in lung and genitourinary tract. Nonsmoking is also required to minimize the risk of atherosclerosis In this session, we will review 1) the long-term safety and 2) clinical importance of follow-ups by nephrologists in living kidney donors.