Historically, patients over the age of 70 were not considered candidates for kidney transplantation. However, age has become a less important contraindication for listing a patient for transplant, according to kidney and pancreas transplant specialist Goni Katz-Greenberg, MD, Duke's associate medical director for kidney transplant.

“A 70-year-old today is not the same as in the 1980s or 1990s. They’re usually stronger and more robust,” says Katz-Greenberg, who presented on this topic at the June 2024 American Transplant Congress. “Data show the largest growing population for patients with end-stage kidney disease is 65 and over.”

The Organ Procurement & Transplantation Network reports that from 2000 to 2024, kidney transplants among patients over 65 increased sixfold, more than triple other age groups’ growth. Similarly, Duke increased kidney transplants in this age bracket each year since 2022. Duke also performed the most overall kidney transplants in North Carolina in 2024, with the highest one-year conditional survival rate.

Older patients require the same type of transplant evaluation as younger patients. “In particular, we pay closer attention to heart studies and CT to make sure they have adequate cardiac function and there are no prohibitive calcifications around their vessels,” Katz-Greenberg says.

“We also take special note of ‘frailty measurements,’” she adds. These frailty measures include the sit-to-stand test, the six-minute walk test, and the hand-grip test. “Although age is associated with frailty, when I think of some of our senior transplant recipients, the last thing you’d say is that they’re frail,” says Katz-Greenberg.

Not all centers accept patients over 70. However, Katz-Greenberg has found that among her patients at Duke, “Patients in this age category tend to do well with transplant.”

With limited available organs, all kidney transplant recipients face a wait. “If a 70-year-old patient just starting dialysis comes to us, they could be waiting a long time,” says Katz-Greenberg. “If they have a living donor, we can do a transplant now. We encourage physicians to urge patients to find a living donor.”

Across all age groups, living donation can hasten transplant. Even if a willing donor lives too far away or is not a match, options like paired donor exchange, remote donation, and voucher donation shorten patients’ wait times and help others awaiting lifesaving care.

“We want physicians to know patients over 70 have options,” Katz-Greenberg says. “Nationwide, transplant among seniors has increased, and we’re making efforts to do that at Duke as well.”