*Purpose: In 2016, the Springfield Memorial Hospital (SMH) Transplant Program implemented a modified assessment for all renal transplant candidates undergoing evaluation in an effort to improve outcomes. Assessments for all candidates older than 65 years included at least: 1) calculation of depression score, 2) multipoint frailty assessment (Fried Scale), 3) Charleson comorbidity index score, 4) Modified Minnesota Leisure Time score, 5) Montreal Cognitive Assessment, 6) Six Minute Walk test, and 7) evaluation by both nephrologist and transplant surgeon. The purpose of this study was to compare outcomes (graft and patient survival) before and after the implementation of these revisions.

*Methods: Data from all patients who underwent renal transplant were collected and compared between pre (2013-2015) and post (2017-2019) implementation of the revised eligibility assessment. Demographics, donor characteristics, degree of HLA matching, intraoperative variables, and one and three year graft and patient survival were compared.

*Results: We analyzed 157 patients (pre cohort: N=75; post cohort: N=82 for 1 year outcomes, N=46 for 3 year outcomes). Baseline patient demographics (except age, pre: 61 vs post: 53 years, p-0.0001), donor and allograft characteristics, and intraoperative variables were similar between cohorts. Both graft and patient survival at one year post transplant were significantly better in the post cohort compared to the pre-cohort (graft survival: 96% vs 84%, p-0.0079; patient survival: 99% vs 88%, p-0.0068). With smaller sample size in the post cohort at 3 years, neither graft nor patient survival demonstrated a significant improvement in the post cohort (graft survival: 93% vs 84%, p-0.1154; patient survival: 93% vs 81%, p-0.0620).

*Conclusions: Implementation of modified selection criteria for kidney transplant candidates correlated with decreased average age of transplanted patients without reducing the number of transplants performed. Patients undergoing renal transplant after selection based on the revised criteria had better one year graft and patient survival than did a similar cohort before implementation of these criteria. The study was underpowered to detect significant differences in 3-year outcomes. Based on this preliminary data, SMH Transplant program continues to use these selection criteria for our renal transplant candidate evaluation.

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