Is Age Just a Number? Access to and Outcomes in Kidney Transplant Recipients ≥65 Years of Age.

Abstract

Individuals 65 years of age or older represent the fastest-growing segment of the US and end-stage renal disease (ESRD) populations. This analysis assessed trends in kidney transplant (KTX) access and outcomes in patients younger than 65 vs 65 years or older. We conducted a longitudinal cohort study using merged United Network of Organ Sharing, United States Renal Data System, and Vizient data. United Network of Organ Sharing included patients waitlisted and transplanted at the study institution through 2025. United States Renal Data System provided ESRD prevalence (2020 to 2022), and Vizient provided outcomes data (2022 to 2024). ESRD prevalence was nearly fourfold higher in individuals 65 years of age or older vs younger than 65 (6.0 vs 1.6 per 1,000). The proportion of individuals 65 years of age or older added to the institutional KTX waitlist rose from 2% in 1990 to 22% in 2025, whereas they represented 43% of patients with ESRD. KTX outcomes (2022 to 2024) included 974 patients (759 younger than 65 vs 215 65 years or older). Groups were similar for sex and race or ethnicity. Patients 65 years of age or older had lower BMI, shorter dialysis duration, longer waitlist time, higher diabetes prevalence, and more marginal donor organs. Perioperative outcomes and resource use were similar. Older patients had higher rates of delayed graft function and discharge to rehabilitation but similar length of stay, complications, readmissions, and costs. Graft survival was excellent and comparable between groups. Overall mortality was very good, slightly lower at 2 to 3 years in those 65 years of age or older. Patients 65 years of age or older represent the fastest-growing ESRD segment. Although KTX access has improved, older patients remain underrepresented on waitlists. Outcomes and costs for select older recipients are comparable to younger patients. Further research is needed to safely expand KTX access in this population.