The elderly ESRD population in the US continues to grow. National data demonstrates that both patient (PS) and graft survival (GS) at 1 and 5 years is worse in patients age 65 and up compared to patients ages 18-64 at the time of kidney transplant (KT) (Table 2). We examined outcomes in septuagenarian patients (age >70 at transplant).

Methods: We studied patients receiving KT between July 2001 and September 2013. We excluded dual organ transplant and those receiving KT after other solid organ transplants. We identified 145 patients age ≥70 at time of KT and compared them to 924 patients age <70 at the time of KT. We compared the two groups for demographics, transplant characteristics, post-transplant function, post-transplant complications. Biopsies for cause were performed as well as protocol biopsies at 1 mth, 4-6 mth, and 1 year. Rejection includes subclinical rejection and Banff borderline rejection. All were treated.We compared % graft loss due to death with functioning grafts (DWFG) and 1 and 5 year PS, GS, and death censored graft survival (DCGS).

Results: Over a 12 year period, we had 145 KTs in pts ≥70 years of age. Tacrolimus base therapy (>97%) was used after KT with 92.3% (<70) and 98.6% (≥70) recipients receiving some type of induction (p=NS). Rapid steroid taper occurred in 51.9% (<70) vs. 38.6% (>70, p=0.05).

Conclusions: Five year PS is acceptable in the septuagenarians. The use of ECD kidneys is more common in older recipients and yet one year renal function is excellent. DCGS and short-term PS in the septuagenarians are equivalent to the younger population. Patient death with functioning graft is the most common cause of graft loss in the septuagenarian. Outcomes in septuagenarians may be enhanced by careful selection.

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