The number of elderly patients with chronic renal failure is increasing as the population ages. Kidney transplantation is a growing therapeutic option for this population. Nevertheless, organ shortage remains a problem, and a potential worst outcome in this setting is a particular barrier for transplants among older individuals. This study investigates the impact of age on post transplant complications, graft and patient survival.

From 1998-2010 about 7000 kidney transplants were performed in our institution. Information about all 366 patients over 60 years-old in this period were assessed (Group A). As a control group we paired 366 younger patients by sex, donor type (deceased or living) and year of transplantation (Group B). Data were analyzed using Kaplan-Meier and Chi Square tests.

Both groups were similar in immunological risks before transplant, but different for the cause of renal disease, with Diabetes accounting for a significantly higher cause in the elderly (44%) compared to the younger group (12%) (p=0.002, for all causes).

Cardiovascular complications (12,3%), Cancer (6,8%), Hospital readmissions (77,3%) and Delay Graft Function were more common among aged recipients, even though donor features were the same for both groups. On the other hand, New Onset Diabetes (28%) and Acute Rejection (24.6%) frequencies were similar between groups.

Global graft survival in ten years were different between groups: 39,4% for Group A and 67,1% for Group B (log-rank<0,001). Death-censored 10 years graft survivals were similar for both groups: 75% for older and 81,1% for younger patients (log-rank=0,234). Patient survival rates for Group A were significantly worst at ten years (54% versus 83,4% log-rank <0,001).

The most important cause of graft loss was death for both groups, but in the older, it was responsible for 64% versus 44% for the control group (p=0.023). The most important cause of death was infection followed by cardiovascular disease for both groups too, but with similar proportions.

This is the first study comparing the evolution of elderly patients and young adults with 10 years of follow up. It shows equivalent death- censored graft survival for both younger and older patients besides the difference in these two groups for patient survival. The proportion of graft losses caused by death among older patients explain most of the difference observed in global graft survival curves.

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