Clinical Outcomes of Living Donor Kidney Transplant in Older Recipients: A Retrospective Single-Center Analysis.

Objectives: We evaluated living donor kidney transplant outcomes in older recipients (≥65 years) at Armed Forces Hospitals in the Southern Region from September 2017 to January 2025 and compared results versus younger recipients (<65 years).

Materials and methods: This was a retrospective analysis of 68 older patients (group A) and 316 younger patients (group B) who received tacrolimus, mycophenolate mofetil, and prednisone, with basiliximab induction in 94.1% of group A and 92% of group B. Retransplant occurred in 5.9% of group A and 7.9% of group B.

Results: Older recipients had longer dialysis durations versus younger recipients (4 vs 2 years; P < .001), longer surgeries (230 vs 180 minutes; P < .001), and longer hospital stays (7.5 vs 6.2 days; P < .001), higher rates of delayed graft function (8.8% vs 0.6%; P < .001), and lower immediate graft function (91.1% vs 97.7%; P = .006). At 1 year in group A and group B, graft survival rates (95.5% vs 97.1%; P = .501) and patient survival rates (95.5% vs 98.1%; P = .545) were similar. However, by 3 years, graft survival was lower in group A (86.7%) versus group B (92%) as was patient survival (85.2% vs 93.6%; P < .001). Graft loss within 3 years occurred in 4.4% of older versus 1.89% of younger recipients, and death with a functioning graft was more common in group A (7.3%) than in group B (2.2%). Group A also had higher rates of complications than group B (infections: 13.2% vs 6.3%; surgical site infections: 5.9% vs 0.6%).

Conclusions: Despite higher risks, group A demon-strated 1-year graft and patient survival rates that were comparable with group B, highlighting feasibility of kidney transplant in well-selected older adults. However, nonadherence was associated with higher infection rates but did not significantly affect long-term outcomes.