Over the past decade, the amount of elderly patients living with CKD and on dialysis has increased in part due to the survival benefit of transplantation over dialysis. Racial disparity in graft survival has been well described in the entire transplant population. African Americans are prone to reduced graft survival compared to Caucasians and other races after deceased and living donor transplants. The effect of race on graft survival has not been tested specifically among older kidney transplant recipients.

We investigated if a difference in death-censored graft survival exists between all kidney transplant recipients over the age of sixty in the UNOS database who were transplanted between July 1996 and October 2010. We excluded all patients younger than sixty at the time of kidney transplant, patients with a second kidney transplant and patients with a simultaneous liver, heart, lung, pancreas and intestine were all excluded from the study.

Of the 44,013 patients in the sample, 20% were African Americans, 63% Caucasians, 11% Latinos, 5% Asians and the rest other racial groups. The patients were predominantly male with a mean age 65.8 years. 83% of patients had undergone pre-transplant dialysis prior to transplantation and 70% had deceased donor transplantation (DDRT). A total of 82% of AA compared to 64% of Caucasians had a DDRT. Using a cox proportional model, we found that compared to Caucasians, elderly AA were more likely to have graft failure Using a cox proportional model, we found that compared to Caucasians, elderly AA were more likely to have graft failure when we adjusted for confounding factors (hazard ratio 1.55, 95% CI 1.4-1.7). We adjusted for confounders such as age, sex, pre-transplant dialysis, type of kidney, age of donor kidney, HLA mismatch level, presence of rejection episode, employment status and cold ischemia time. There was no significant difference seen in graft survival when we compared the elderly Caucasian patients with the Asians or Latinos respectively.

Elderly AA are at an increased risk of graft loss compared to Caucasians. The racial disparities seen in graft survival in AA persist in the elderly age group. As the elderly are becoming a greater percentage of a growing kidney transplant population, it will be imperative to identify the factors that affect outcomes peculiar to this age group.

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