Old patients constitute almost half of all new patients accepted in to renal replacement therapy programs. The purpose of this study was to evaluate graft and patient survival in first –time kidney transplant recipients 50 years or older. From 1989 to 2004, 485 renal transplantations from live donor were performed at Ghaem Medical Center, Mashad, IRAN. We reviewed the clinical course of 45 recipients, 50 years old or older (mean age 52/93), of first kidney transplants. Patients and graft survival were compared with 47 patients younger than 50 years (mean age 25.23) transplanted during the same time period. In patients 50 years old or older, graft survival at one and five years was 72% and 41%, and patient survival at one and five years was 72% and 41%, respectively. In patients less than 50 years old, graft survival at one and five years was 95% and 85%, and patient survival at one and five years was 95% and 89%, respectively. The overall graft survival was significantly better in younger compared with older recipients (P=0.0068). A similar pattern was seen for patient survival (P=0.0072). The difference in graft survival in the elderly compared with younger recipients was due to more death in the older recipients. Renal transplantation is a safe and effective therapy for the older renal failure patient. Graft survival in patients aged 50 or older is good, with most graft loss occurring secondary to patient death.