As life expectancy is increasing, more elderly patients are getting the status of end-stage renal disease (ESRD). The best treatment for ESRD is kidney transplantation (KT). However, there are some concerns about graft survival and complications such as infection and malignancy in elderly kidney transplant recipients. Also, the safety and graft function is not confirmed in KT with old kidney donors. The outcomes of KT in elderly patients are various in several studies. Living donor recipients showed immediate survival benefits over dialysis, but increased mortality compared to dialysis was observed in deceased donor KT in a study. Because a lot of factors can affect the outcomes of KT, some researchers analyzed the risk factors of poor outcomes in elderly recipients and made clinical prediction scores. Also, the association between frailty and KT outcomes was reported. Therefore, frailty tests can be useful tools for evaluating elderly recipients and donors. Immunosenescence is also an important issue when considering KT in elderly patients. However, more studies are necessary for evaluating immunologic changes and outcomes in elderly recipients. Appropriate immunosuppression in elderly recipients should be more evaluated. The number of elderly KT recipients and donors is increasing, so more studies are necessary for proper patient selection and management of them.