The allograft survival of kidneys from living donors aged ≥65 years is similar to that of younger living donors in recipients aged ≥35 years.

Concerns about kidney longevity may limit the use of kidneys from living donors aged ≥65 years. Previous studies have not considered competing risks of death or effect modification by recipient age. We studied 106 966 living donor recipients in the Scientific Registry of Transplant Recipients between 2000 and 2020, including 2376 with donors aged ≥65 years, for the outcome of allograft failure defined by return to dialysis or repeat transplantation. In a multivariable model accounting for the competing risk of death, the impact of donor age of ≥65 years varied by recipient age: compared with recipients aged <35 years with donors aged <35 years, the subdistribution hazard ratio (SHR) for allograft failure in recipients of donors aged ≥65 years were as follows: SHR, 1.77 (95% CI, 1.15-2.27), among recipients aged <35 years; SHR, 1.14 (95% CI, 0.6-2.18), among recipients 35 to 49 years; SHR, 0.72 (95% CI, 0.38-1.39), among recipients aged 50 to 64 years; and SHR, 0.65 (95% CI, 0.33-1.29), among recipients aged ≥65 years. We conclude that the allograft survival of living donor kidneys from those aged ≥65 years is similar to that of living donors aged <35 years in recipients aged ≥35 years.