Organ shortage is a major problem in the treatment of end-stage renal disease (ESRD). It is obvious then, that cadaveric donors provide an effective solution to organ shortage. Many factors that can affect the functioning and survival of cadaveric kidneys have been studied. In this study, we aimed to clarify the impact of donor age and acute rejection episodes on long-term graft and patient survival in cadaveric renal transplant patients. Long-term outcome of 207 cadaveric renal transplant recipients who had received transplants between 1985 and 2004 were retrospectively evaluated. Mean recipient age; HLA mismatch; mean donor age; delayed graft function (DGF); mean cold ischemia time; acute rejection episodes during the first 6 months after transplantation; and 1-, 3-, and 5-year graft survival rates were evaluated. There were two study groups according to donor age. Recipients in group 1 (n = 126) received kidney from donors aged younger than 50 years, and recipients in group 2 (n = 81) received kidney from donors aged 50 years and older. Mean recipient age, HLA mismatch, and mean cold ischemia time of the groups were not different. The delayed graft function rate in group 1 was 40% (n = 50); it was 46% (n = 37) in group 2 (P > 0.05). One-, 3-, and 5-year survival rates of patients without acute rejection within the first 6 months after transplantation in group 1 (58/126, 46%) versus those in group 2 (46/81, 57%) were 95% versus 90%, 65% versus 60%, and 40% versus 35%, respectively (P > 0.05, Kaplan-Meier analysis). The 1-, 3-, and 5-year graft survival rates of patients with acute rejection within the first 6 months in group 1 (n = 68) versus those in group 2 (n = 34) were 93% versus 89%, 71% versus 55%, and 28% versus 44% (P = 0.005). One-, 3-, and 5-year patient survival rates with DGF in both groups were not significantly different. In this study, acute rejection within the first 6 months after cadaveric transplantation, especially in patients who had received kidney from donors aged older than 50 years, significantly affected 5-year survival of kidney grafts. However, cadaver age by itself did not have an impact on 5-year graft survival rate.