Kidney Transplantation in Older Recipients: One-Year Outcomes and Complications from a Single-Center Experience

Background/Objectives: Each year, the number of kidney transplants (KT) performed in older recipients continues to rise. The process of aging may impact early post-transplant outcomes. The aim of this study was to analyze one-year outcomes, clinical and surgical complications, as well as patient and graft survival in senior recipients. Methods: This retrospective, observational study included a total of 270 participants who underwent KT during the period between January 2021 and April 2024. Recipients were divided into two groups: the older group (≥60 years; n = 75) and the younger group (<60 years; n = 195) and then analyzed during a one-year follow-up period. Results: Older recipients were characterized by a higher body mass index (MD = 1.77, CI95 0.63; 2.91, p = 0.002), suffered more often from diabetes mellitus (RR = 2.94, CI95 1.79; 4.82, p < 0.001), cardiovascular diseases (RR = 5.20, CI95 2.90; 9.32, p < 0.001) and were more likely to receive a kidney from older (MD = 12.37, CI95 8.94; 15.80, p < 0.001) deceased (p < 0.001) donors. Senior patients had more infections (p = 0.019) and surgical complications (RR = 1.81, CI95 1.14; 2.87, p = 0.020), more cardiac events (RR = 2.28, CI95 1.17; 4.43, p = 0.025), and a higher incidence of delayed graft function (p < 0.001) compared to younger patients. The estimated glomerular filtration rate (eGFR) was significantly lower in the older group both at initial hospital discharge (MD = −6.50, CI95 −13.00; −3.00, p = 0.004) and at one-year follow-up (MD = −11.79, CI95 −17.32; −6.25, p < 0.001). No differences were observed in the incidence of biopsy-proven acute rejection, cytomegalovirus replication, and polyomavirus replication. One-year patient and graft survival was 97.3% and 94.7% in the older group, and 98.5% and 96.9% in the younger group, respectively. Conclusions: Kidney transplantation in older recipients is safe in the short term. Although eGFR was lower in the older group, it remained within an acceptable range.