*Purpose: In Japan, the spousal kidney transplantation accounts for approximately 40% out of whole living kidney transplantation. In addition, about half of whole living donors are over 60 years old. Transplantations from elderly donors have been shown to display impaired long-term graft outcomes. We aimed to examine whether spousal kidney transplantation of elderly donors is clinically acceptable.

*Methods: We included 98 recipients with living donor kidney transplantation between 2006 and 2020 in this study. We compared to examine 27 cases of living kidney transplantation from elderly spousal donors aged 60 years or older (group A) and 34 cases of living kidney transplantation from elderly related donors aged 60 years or older (group B). Twelve donors (44.4%) in Group A were male, that is, their husbands, and 31 donors (91.2%) in group B were parents of recipients.

*Results: The median donors’ age of group B was significantly older than that group A (64 years old vs 72 years old, p<0.05), On the other hands, the median recipients’ age was significantly older in group A than that in group B (66 years old vs 45 years old, p<0.001). Blood type incompatibility was significantly higher in group A than in group B (44.4% vs 20.6%; p<0.05). Seven recipients (25.9%) in group A and 6 recipients (17.6%) in group B had preformed donor specific antibodies (DSAs), but there was no significant difference. Four recipients (14.8%) in group A had de novo DSAs after transplantation, which was significantly higher than that in group B (0%; p<0.05). Human leukocyte antigen incompatibility is significantly higher degree in group A (p<0.001). Rituximab was used significantly more frequently in Group A than in Group B because of, for example, blood type incompatibility, presence of DSAs, and pregnancy history (96.3% vs 52.9%; p<0.001). The volume of donated kidney was measured by CT, but there was no significant difference between the two groups. Graft function tended to be superior in group A, but there was no significant difference in the long term, and there was no significant difference in rejection rate or graft survival rate.

*Conclusions: Using suitable immunosuppressive regimen, the outcomes of elderly spousal transplantation are also satisfactory.

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