Comparable outcomes for old, older and very old deceased donors in old kidney transplant recipients

Older patients (≥65 years) account for nearly one-third of the kidney transplant waiting list, with high waitlist mortality that could be prevented by early transplantation, even with (very) old donor kidneys. However, data on outcomes of old deceased-donor kidneys are sparse. This retrospective cohort study evaluated outcomes of kidney transplants from deceased donors ≥65 years in recipients ≥65 years in the Netherlands between 2005 and 2022. Donors were categorized as old (65-69), older (70-74), and very old (≥75). Declined kidneys from these donors were also analyzed. Among 1301 recipients, patient and death-censored graft survival at 1 year (90.6% [95% confidence interval {CI}, 89.1-92.2] and 90.2% [95% CI, 88.0-91.7]) and 5 years (60.1% [95% CI, 57.2-63.1] and 86.0% [95% CI, 84.0-88.0]) did not differ significantly across donor age groups. Cox regression showed no significant association of donor age with patient or death-censored graft survival. There was notable overlap in the characteristics of declined and transplanted kidneys. Overall, patient and graft survival were comparable for kidneys from old, older, and very old donors. Exploratory analyses suggested additional donor potential in the very old donor category. These findings support broader acceptance of old donor kidneys to reduce waiting time and waitlist mortality in older kidney transplant candidates (≥65 years).