Background. Kidney transplantation outcomes have improved in the short term, but long-term graft survival gains have plateaued. Aging donors and recipients with increasing comorbidities may alter contemporary allograft outcomes. Methods. We retrospectively analyzed 2076 consecutive kidney transplants performed at a single Canadian center from 1969 to 2024, representing up to 50 y of complete follow-up. All-cause graft survival (ACGS) and death-censored graft survival were compared across 5 transplant eras using era-stratified Cox regression. Results. The median recipient age increased significantly across the eras from 35 to 54 y ( P 60% of graft losses in recent years, with infectious deaths rising from 21% to 45% ( P < 0.01). Increasing donor and recipient age, comorbidities, and delayed graft function independently predicted inferior survival. Conclusions. These findings reveal a reversal in ACGS gains in the contemporary era, highlighting the need for precision immunosuppression strategies tailored to the aging, comorbid transplant population.
Wiebe et al. (Mon,) studied this question.