*Purpose: The shortage of deceased donors and increase in the aging population have led to increased kidney transplantation using older living donors (LDs) in Japan, like in many other countries. Recently, the proportions of kidney LDs in their 60s and 70s were shown to be over 30% and 10%, respectively. We analyzed the long-term outcomes of kidney transplantation from older LDs.

*Methods: In total, 741 patients with end-stage kidney disease who underwent living kidney transplantation between 2000 and 2010 were included. They were divided into three groups by LD age: <60 (n=458), 60-69 (n=231), and ≧70 (n=52) years. The end-points were death-censored graft and patient survival, biopsy-proven rejection, renal function of both recipients and donors, and complications.

*Results: The mean donor ages were 50.4 years in the LD age <60 years group, 63.8 years in the LD age 60-69 years group, and 73.4 years in the LD age ≧70 years group. The recipient age decreased in order of the LD age ≧70, 60-69, and <60 years groups. The 10-year patient survival rates were 97.2%, 92.6%, and 86.5%, respectively. The LD age <60 years group had significantly higher patient survival than the other two groups. The 10-year death-censored graft survivals were 91.7%, 87.9%, and 67.3%, respectively. The LD age ≧70 years group had a significantly higher graft failure rate than those of the other two groups, but there was no significant difference between those of the LD age <60 and 60-69 years groups. The incidence rates of biopsy-proven rejection were similar in the three groups. Graft function worsened in order of the LD age <60, 60-69, and ≧70 years groups. The LD age >70 years group had lower donor kidney function until 2 years after donor nephrectomy, but there was no significant difference in the three groups >3 years after surgery. The incidence rate of urinary tract infection in the recipients was higher in the LD age >70 years group, and that of hyperuricemia was lower in the LD age <60 years group. There were no significant differences in the recipients of the three groups in the incidences of cytomegalovirus infection, pneumonia, anemia, and hypertension.

*Conclusions: Recipients of 60-69-year-old donors had similar outcomes as those of <60-year-old donor recipients. However, recipients of ≧70-year-old donors had lower patient and graft survival. Kidney function continued to improve even in ≧70-year-old donors.

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