Comparative Analysis of Graft Survival in Older and Younger Kidney Transplant Recipients: A Single-Center Cohort Study

<b>Background/Objectives:</b> We hypothesized that older recipients have a higher rate of kidney graft failure compared to younger recipients. Thus, we assessed 60-month kidney graft failure (KGF) among deceased donor recipients aged 65 years or older and compared it with that of younger recipients. <b>Methods:</b> A single-center, retrospective cohort study was conducted at Son Espases University Hospital in Palma, Spain, including all consecutive deceased donor kidney transplant recipients from 2011 to 2021. The primary outcome was 60-month KGF, analyzed using the cumulative incidence function (CIF). A multivariable semi-parametric Fine and Gray model was used to estimate the subhazard of KGF in older versus younger recipients, adjusting for variables associated with recipients aged 65 years or older, including KGF and overall survival. <b>Results:</b> The study included 618 recipients, with a median age (interquartile range) of 58 years (47-66 years); of these, 187 (30%) were aged 65 years or older, and 498 (81%) received grafts from donors after brain death. The 60-month CIF (95% confidence interval) of KGF for the entire cohort was 12% (9.1-15). Candidate variables for multivariable analysis included recipient sex, body mass index, donor age, presence of hypertension or diabetes, donor sex, length of hospital stay, cold ischemia time, donor type, multiple renal veins, and Clavien-Dindo grade ≥ 3 complications. After adjustment, KGF risk did not significantly differ between age groups (sHR: 0.75; 95% CI: 0.41-1.38; <i>p</i> = 0.36). <b>Conclusions:</b> Despite having worse baseline characteristics, receiving lower-quality grafts, and experiencing a higher incidence of postoperative complications, we observed comparable 60-month kidney graft survival in older recipients relative to younger ones. These findings support the viability of kidney transplantation in well-selected older patients.