Five-Year Patient and Graft Outcomes After Living Donor Kidney Transplantation From Donors Aged 60 Years and Older: A Single-Center Cohort Study.

BACKGROUND: Using older living donors is a strategy to expand the kidney donor pool, but concerns remain regarding mid-term graft performance. We evaluated 5-year patient and graft outcomes after living donor kidney transplantation from donors aged 60 years and older versus younger donors. METHODS: We conducted a single-center retrospective cohort study of 279 living donor kidney transplants. Recipients were grouped by donor age (<60 years, n = 237; ≥60 years, n = 42). To reduce selection bias, inverse probability of treatment weighting was applied. Outcomes included longitudinal recipient estimated glomerular filtration rate (eGFR), patient survival, and death-censored graft survival. RESULTS: Unadjusted 5-year death-censored graft survival was lower in the older-donor group (90.2% vs 98.2%, log-rank p = .0056). After weighting, the difference was attenuated (94.6% vs 98.3%), with a restricted mean survival time difference over 60 months of -0.24 months (95% CI, -1.02 to 0.24). Recipients of kidneys from older donors had modestly lower mid-term eGFR, generally by 4-7 mL/min/1.73 m². Five-year patient survival did not differ significantly between groups. CONCLUSIONS: Kidney transplantation from carefully selected living donors aged 60 years and older was associated with acceptable 5-year patient and graft outcomes. Although graft function was modestly lower, adjusted analyses did not identify donor age ≥60 years as an independent predictor of graft loss. These findings support expanding living donor criteria in regions with organ shortage, particularly in low- and middle-income country settings.