*Purpose: According to national data, there is an increase in kidney transplants in patients over 65, corresponding to an overall general increase. Elderly patients continue to be transplanted at lower rates than others. This is likely due to factors including stringent selection criteria, decreased interest among older patients or a perception of limited utility of transplantation in the elderly. Using data from a rural kidney transplant population in eastern North Carolina, we evaluated long-term graft survival among elderly recipients of deceased and living donor transplants.

*Methods: A single center study from a transplant program in eastern North Carolina was performed by collecting data from a total 1524 kidney transplant patients. The transplant period was between 1995 and 2020. Patients were stratified into two categories, age below 65 (Group 1) and age older than 65 (Group 2). Donor and recipient characteristics were compared between age groups using the two-sample t-test or chi-square test, where appropriate. Graft survival (time to graft loss/death) was estimated using the Kaplan-Meier method, while the probabilities of graft loss and death were estimated using the cumulative incidence function. Multivariable Cox’s cause-specific hazard model was used to evaluate the association of age group with risk of graft loss/death. Hazard ratio (HR: Group 2 vs Group 1) and 95% confidence interval (CI) are provided.

*Results: Organs for recipients over 65 were more likely to be older, have higher KDPI (>85%), qualify as ECD, as well as have a history of hypertension/diabetes (Table 1). One-, 5- and, 10 year graft survival rates were 92%, 62% and 32%, respectively in Group 2 compared to 93%, 74% and 49% in Group 1 (<0.001). Probability of graft loss/death at 1-, 5- and 10-years post-transplant was 3%/6%, 8%/30%, and 13%/55% in Group 2 compared to 4%/3%, 15%/11%, and 27% /24% in Group 1. Adjusted HR for death-censored graft loss for Group 2 vs Group 1 was 0.626 (95% CI: 0.407,0.960; p=0.032). When looking at risk of death with functioning graft, the adjusted HR was 2.481 (95% CI: 1.937, 3.178).

*Conclusions: The majority of elderly recipients with graft failure were due to death with a functioning graft. Future areas to explore are the reasons for cause of death in this population. This study also demonstrates that organs that are typically considered marginal (older age, ECD, higher KDPI) can successfully be used in the elderly population and may help reduce the organ discard rate.

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