Background: The upper age limit to receive a kidney transplant has progressively risen, but the outcomes of elderly (ages > 70) transplant recipients remain understudied. We therefore evaluated mortality, graft failure, and predictors of these outcomes in this population.

Methods: Three cohorts of recipients transplanted between 1963 and 2012 (ages < 60 years [n=3775], 60-70 years [n=568], and > 70 years [n=133] at transplantation) were compared for allograft and patient outcomes.

Results: Death-censored graft survival was higher in recipient's aged > 70 years: 5-, 10-, and 15- years was 92.7%, 84.8%, and 72.7%; for ages 60–70 years, it was 88%, 75.6%, and 74%; and for ages < 60 years was 81.2%, 71.9%, and 62.3%. Among factors associated with increased graft failure in both those < 60 years and those 60 -70 years included transplantation year < 2000, African American race and cellular rejection. In those ages ≥ 70 years, antibody-mediated rejection < 1 year and use of azathioprine were associated with graft failure. The 5-, 10-, and 15-year patient survival rate was 69.3%, 26.6%, and 9.0% for those aged > 70 years; 72.4%, 48.4%, and 25.3% for those ages 50–64 years; and 80.2%, 63.4%, and 48.3% for those ages < 60 years. Transplantation year < 2000, diabetes, and deceased donor kidney transplant were associated with increased mortality in those < 60 and those 60-70 years old. Factors associated with increased mortality in those > 70 years included diabetes at transplant and use of steroids.

Conclusions: The overall outcomes of transplantation in elderly kidney transplant recipient's aged > 70 years are excellent, but the risk factors for mortality and graft failure are distinctly different than those observed in younger recipients.

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