In this study we reviewed our data of renal transplants performed using organs from very old cadaveric donors (VEDs) (donor age >= 70 years old) to assess whether this donor population is safe to use for kidney transplantation (KTx). From January 2000 to August 2004, we evaluated 82 donors >= 70 years old (mean age 74.3 ± 3.3, range 70-85 years). Our selection criteria were based on clinical assessment and both macroscopic and histological evaluation (HE). In 44 cases, the kidneys were not used for the following reasons: atherosclerotic vascular lesions involving the renal arteries (31), donor cancer (6), multiple renal cysts (4), pyelonephritis (1), fibrodysplasia of the renal artery (1), HE (1). On the basis of histology, 26 donors were selected for DKT and 12 for SKT. We performed a total of 39 KTx (26 DKT, 13 SKT) in recipients with a mean age of 60.5 ± 3.6 years (range 50-70) and a mean HLA matching of 1.3 ± 1. Immunosuppression was induced with basiliximab in 19 patients or ATG in 15, while it was maintained using a triple-drug therapy, that was cyclosporine-based in 29 patients and sirolimus-based in 10, combined with MMF and steroids. The mean CIT was 15.4 ± 3.8 hours. The mean follow-up is 25.8 ± 16.6 months. Two early graft loss occurred; in 1 case the donor was 85 years old and in the other graft loss was due to graft venous thrombosis in a patient with thrombophilia for Factor V Leiden. The percentage of ATN was 43.6% (mean duration 10.6 ± 7.3 days). We had no surgical complications. The incidence of acute rejection was 17.9%. Renal function was acceptable at discharge (mean S-Cr 207.1 ± 118.3 µmol/L), satisfactory at 1 and 2 years (mean S-Cr 149.6 ± 63.2, 148.5 ± 60.7 µmol/L, respectively). The 1 and 2 years graft survival is 94.9% and 82.9%, while the 1 and 2 years patient survival is 100% and 97.4%, respectively. One patient died with functional graft due to myocardial infarction. Judging from our experience with VEDs, appropriate selection criteria (including HE) is crucial to establishing when kidneys should be discarded and when they are suitable for SKT or DKT to achieve optimal results in terms of graft survival and renal function.