*Purpose: Kidney transplantation offers survival benefit and improved quality of life in end-stage renal disease patients. Because the waiting list continues to grow, there has been an increase in the utilization of kidneys from older donors. We examined the racial disparities in graft and patient outcomes of patients after transplantation with old kidneys.

*Methods: We identified 19,820 kidney transplant recipients based on donor age ≥ 60 year between January 2000 and December 2016 from the United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research data. Using case-mix adjusted logistic regression models; we examined the effects of race on 3-year death censored graft loss (DCGL) and 3-year recipient survival in kidney transplant recipients (KTR) of elderly donors.

*Results: Elderly donors accounted for 7.9% of all donors. Of the 19,820 recipients of old kidneys, 57.9% were Whites, 22.8% were Blacks, 6.4% were Asians, 11.1% were Hispanics and 1.9% were others. 45.6% were males. Mean donor age was 64±3 years and mean recipient age was 59±11 years. Overall, 3-year DCGL was 12% and 3-year recipient survival was 86.2%. In adjusted analyses, Blacks were more likely than Whites (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.08-1.36, p<0.001) to experience DCGL at 3 years. Additionally, both Hispanics (OR, 0.77; CI, 0.66-0.91, p=0.002) and Asians (OR, 0.72; CI, 0.58-0.90, p=0.003) were less likely than Whites to experience DCGL at 3 years. In adjusted analyses, Blacks (OR, 0.83; CI, 0.74-0.92, p<0.001), Hispanics (OR, 0.71; CI, 0.61-0.82, p<0.001) and Asians (OR, 0.75; CI, 0.62-0.90, p<0.001) were less likely than Whites to die at 3 years after receiving a kidney from an elderly donor.

*Conclusions: Among KTR of elderly donors, Blacks are at a 21% higher risk of graft failure than Whites at 3 years but survive longer after transplantation. As compared to Whites, both Hispanics and Asians are less likely to experience DCGR at 3 years less likely to die within 3 years of getting a kidney transplant from an older donor. Further studies are needed to assess additional factors contributing to disparities in graft and recipient survival in KTR of old kidneys.

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