*Purpose: Previous analyses comparing elderly kidney transplant recipients (KTR) to younger KTR found that elderly patients suffered higher rates of mortality, less biopsy-proven acute rejection (BPAR), and similar graft survival. A national cohort of patients is presented to validate these results. As the number of elderly KTR increases, differences between this population and younger are unknown.

*Methods: A national retrospective analysis of records of 225021 from 2008-2017 was performed. The study population was divided into two cohorts: (Y: ≤59 yrs; n=52079; E: ≥65 yrs; n=172942). KTR aged 60-64 were excluded to distinguish groups. Graft and patient survival were demonstrated by Kaplan-Meier plots and reliability was tested using a multivariate Cox proportional-hazards model and log-rank test. Rates of rejection at 6 months and 1 year post-transplant were compared and reliability was tested using the Chi-square test. The rate of antithymocyte globulin for induction therapy in each group was also collected.

*Results: Younger KTR were 51 (46, 55) years old and followed for 1114 (385, 2097) days. Elderly KTR were 68 (66, 71) years old and followed for 1063 (365, 1818) days. The overall survival probability is significantly higher in the younger group. The CoxPH models show the younger group has a hazard ratio of 0.36 (p<0.001) compared to the elderly. The elderly patients had significantly less biopsy-proven acute rejections at both 6 months and 1 year post-transplant (p<0.001). Elderly patients experienced rejection at 5.9% (n=27010) at 6 months and 7.2% (n=24359) at 1 year; younger patients experienced rejection at 7.4% (n=75411) at 6 months and 9% (n=69000) at 1 year. Graft survival was similar between groups with the curves crossing at around 1200 days. There was no difference with regard to the use of antithymocyte globulin between groups.

*Conclusions: The national cohort is consistent with previous analyses that demonstrated younger KTR had better long-term survival, while the elderly experienced less BPAR and similar graft survival.

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