AbstractBackgroundOptimal immunosuppression in elderly kidney transplant recipients (KTRs) is not well defined, with mycophenolate mofetil (MMF) being poorly tolerated. Study aim was to compare MMF dose reduction incidence and reason(s) in elderly vs. nonelderly KTRs in the 1st year after transplant with a protocol dose of 1 g/day.MethodsIn this single‐center retrospective study, first or repeat KTRs receiving rabbit antithymocyte globulin (rATG), MMF 1 g/day, tacrolimus, and prednisone, were stratified by age [≥60 (elderly) or <60 years (nonelderly)]. Primary outcome was MMF dose reduction incidence in the first year. Secondary outcomes included dose reduction rationale, 1‐year patient and graft survival, graft function, rejection, infection, hospital presentation, and time to dose reduction. Of 335 KTRs, dose reduction incidence was significantly greater in the elderly group (66% and 54%, p = 0.04), though this did not remain significant when adjusted for sex, race, and valganciclovir use. Most common rationale was leukopenia in the elderly group and CMV in the nonelderly group. There were no significant differences in secondary outcomes.ConclusionsMycophenolate mofetil 1 g/day was poorly tolerated in both elderly and nonelderly KTRs receiving lymphocyte‐depleting induction with a high incidence of dose reductions; however, no short‐term adverse graft outcomes were identified.