*Purpose: Kidney transplantation improves quality of life and survival in all patients regardless of age. However, older patients are prone to development of side effects related to immunosuppressive medications including infections and malignancy. We aim to evaluate clinical outcomes in recipients older than 65 years of age.

*Methods: We retrospectively reviewed all patients over the age of 18 who received an isolated renal transplant at our center from January 2013 to June 2017. We compared clinical outcomes including allograft and patient survival, as well as the development of infections (opportunistic and non-opportunistic) malignancy in patients older than 65 compared to younger patients.

*Results: Of the 624 patients analyzed, 148 (24%) were older than 65 years of age. There was no difference in terms of gender, race, immunosuppressive or induction therapy between the two groups. Older patients were more likely to receive a deceased donor kidney transplant (92% vs. 81%, p=0.009). During a median 48 months (28, 70) of follow-up, as expected mortality was higher in older patients (16% vs. 6.5%, p=0.0001) but there was no difference in terms of death-censored graft loss (10.8% to 9%, p=0.52) compared to younger patients. Detailed analysis of infections revealed that there was no difference in terms of BKV and CMV viremia, pneumonia, bacteremia, influenza and c. diff between the two groups. However, older patients had more fungal and urinary tract infections and malignancy. The most common infection in the elderly was PJP pneumonia occurring in 4%, followed by candidemia 3%, and cryptococcal infection 2%. The most common malignancy in the elderly was skin cancer, occurring in 6% of patients, followed by prostate 2%, lung 1%, and colon 1%.

*Conclusions: Recipients older than 65 had similar graft survival compared to younger patients, but had a higher incidence of fungal and urinary tract infections and malignancies.

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