Eligibility, timing, and organ quality: indications and outcomes of kidney transplantation in older patients.

Kidney transplantation remains the gold standard treatment for end-stage renal disease. The rising prevalence of this condition, at the same time, contributes significantly to the increasing discrepancy between organ supply and demand, impacting the opportunities for treatment while creating challenges for providers and health care systems worldwide. Driven by demographic shifts, the most significant growth in transplant candidates is observed in the older population. Here, we detail characteristics of older recipients who may benefit most from transplantation, with an emphasis on data-driven assessment for candidate selection while also considering the impact of donor organ quality, donation type, and waiting times. Distinguishing between patients with end-stage renal disease who will benefit from transplantation and those who will derive less or no benefit is essential for providing optimal care to older patients while ensuring responsible stewardship of the limited organ supply. We highlight the advantages of preemptive or expedited transplantation to minimize dialysis exposure and address specific considerations for the peri- and postoperative period. Although living donation remains ideal and will shorten the waiting time, kidneys from older or high kidney donor profile index donors show satisfactory outcomes, particularly for older recipients.