Patients aged 65 years and older represent the fastest growing group on the waitlist with the numbers increasing. This trend, although encouraging, fails to highlight the overall low rate of elderly patients waitlisted or transplanted. The elderly population brings with them a unique set of problems, including frailty, cognitive impairment, and comorbidities less commonly seen in the other age groups. All these factors have been associated with morbidity and mortality after transplantation, although the trend has improved. Despite these issues, a number of studies have shown improvement in overall life expectancy (mortality risk 40-60% lower) for those who have received a transplant compared to similar waitlisted patients who have remained on dialysis. This survival advantage persists despite a significantly higher incidence of early mortality in some reports. A number of European and American studies have confirmed that transplantation in advanced age patients is associated with prolonged graft survival, since patient survival is often the limiting factor. On the contrary, other studies have shown higher mortality and worse death-censored graft survival in older recipients using ECD kidneys. Most elderly patients listed for transplantation will receive an ECD kidney, often from an older donor. Consequently, it is important to clarify if there is a survival advantage in using these kidneys compared to remaining on dialysis. In an attempt to minimize confounding factors, a paired-matched analysis has recently been published, comparing 823 recipients from donors over 65 years and counterparts listed with the same comorbidity. The risk for death was 2.66-fold higher in the dialysis group. In another analysis, the outcomes using donors ≥ 75 years were examined. Even using these extreme aged kidneys, the survival benefit was clear with a 60% reduction in mortality for those transplanted compared to the patients remaining on dialysis. Thus, consider age in the context of other comorbidities, including frailty, that may impact outcome when deciding about suitability for kidney transplantation