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Deciding whether an elderly patient with end-stage renal disease is a candidate for kidney transplantation can be difficult. We aimed to evaluate pre- and early posttransplant risk factors that could predict outcome in elderly kidney recipients.Data from all elderly (≥70 years, n=354), senior (60–69 years, n=577), and control (45–54 years, n=563) patients receiving their first kidney transplant at our center from 1990 to 2005 were retrieved. Patient and graft survival were analyzed in a Cox model addressing the common risk factors including Charlson comorbidity index (CCI), pretransplant dialysis time, and early acute rejection episodes.Acute rejection in the first 90 days, Hazard ratio (HR) 1.74 (1.34–2.25); time on dialysis, HR 1.02 (1.01–1.03) per month; and donor age more than 60 years, HR 1.52 (1.14–2.01) predicted mortality in the elderly. CCI score did not predict mortality in the elderly, HR 1.05 (0.98–1.12); but did so both in senior, HR 1.17 (1.08–1.27) and control recipients, HR 1.33 (1.19–1.48). Delayed graft function, HR 3.69 (2.01–6.79); donor age more than 60 years, HR 2.42 (1.30–4.49); and presence of human leukocyte antigen antibodies, HR 3.96 (1.38–11.37) were independent predictors for death-censored graft loss in the elderly.Adequate immunosuppresion with low frequency of rejection episodes improves the outcome for elderly kidney recipients as does a reduction of time on dialysis. CCI score at transplantation does not seem helpful in the selection of elderly patients for kidney transplantation but plays a significant role in patients under 70 years of age.