*Purpose: Renal transplant improves outcomes of well-selected elderly patients with end stage renal disease. Older patients with significant comorbidities may not live long enough to realize the survival benefit of transplant. Screening tools are not widely used but may prove valuable.

*Methods: We performed a single center retrospective analysis of patients referred for kidney transplant between January 2018 and June 2019 over the age of 70. The Mortality Index, originally developed by Dusseux et al (see Table 1) as a risk score of three year mortality in end-stage renal disease, was applied retrospectively to patient’s charts to generate a mortality score. Mortality Index scores were then correlated with patient’s listing outcome. Scores were not used during the listing process.

*Results: Of 1000 patients evaluated, 62 (6.2%) patients were over age 70. Average age of the elderly cohort was 73.9 +/- 2.7; 18/62 (29%) were listed. Average mortality index was 7.76 +/- 3.03 (range 2-14, see Graph 1). No patient with mortality index greater than 10 was listed (14/62 patients, 22.5%). Average mortality index of listed candidates was 6.5 +/- 2.5 versus not listed 8.3 +/- 3.1, p = 0.045 (Graph 2). Binary logistic regression analysis of patient’s age, race, sex and Mortality Index found that only Mortality Index was significantly associated with patient’s listing outcome (OR 0.699, 95% CI 0.539, 0.905, p=0.007).

*Conclusions: A tool such as the Mortality Index may help provide patients with realistic expectations regarding transplant candidacy. Subjectivity in elderly transplant candidate evaluation could be minimized using objective tools. These results need to be validated prospectively.

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