Kidney Transplant Outcomes in Patients Older than 70 Years: A Single-Center Experience

Background: The number of elderly patients with end-stage kidney disease—and those waitlisted and transplanted—continues to rise. Managing older transplant recipients is challenging due to their comorbidities. With our center increasing transplants in patients over 70 (from 6 in 2017 to 19 in 2023), we aim to better understand their outcomes and complications. Methods: We reviewed 96 patients > 70 years old who underwent a kidney transplant (KT) at our center between January 2019 to April 2024. We stratified our data by living (LDKT) or deceased donor (DDKT) transplant status and described the following one-year outcomes: mortality, allograft loss, readmission rates, cardiovascular events, and key infections. Results: The median age at transplant was 71 (IQR 1.3) (Fig 1). LDKT recipients (N=35, 36%) were more likely to be preemptive (63% vs 25% in DDKT), and have a shorter dialysis vintage (0.97 years and 2.04 years respectively). In the first year post transplant, both mortality (due to malignancy, infection and cardiac arrest) and death censored graft loss (due to primary nonfunction, pyelonephritis and a pseudoaneurysm) measured at 3%. The median length of stay was 4 days - with 97% discharged home. 34% of patients were readmitted within 30 days of index admission, and 48% were rehospitalized more than once in the first year. Major adverse cardiac events occured in 7% of patients. Complications included urinary tract infections (38%), BK viremia (20%) and CMV (7%). Conclusion: Our older recipient cohort showed similar trends to those reported in the general KT population. We observed a high BK viremia rate, possibly related to our immunosuppression approach in this vulnerable group. Our goal is to compare this cohort with matched patients under 70 to identify modifiable factors influencing outcomes.