The progressive increase in the elderly population around the world is associated with the increase in the percentage of individuals with chronic diseases such as chronic kidney disease. They constitute new candidates for kidney transplantation as the therapy has been proven to be superior (life quality, survival, cost) compared to dialysis. Some aspects should be considered as elderly individuals present comorbidities (cardiovascular disease, diabetes, hypertension etc.) and changes in the immune system that could impair the success of transplantation at early points of time. Patient death linked to functional kidney allograft occurs in a considerable number of elderly recipients. The decreased immune response has been pointed out as responsible for the lower rates of acute rejection in elderly kidney recipients. However, these patients also present a higher incidence of infections and tumors posttransplantation. Some authors find an increased risk for chronic allograft nephropathy in elderly recipients whereas some authors report similar rates of risk compared to younger recipients. The immunosuppressive regimen is another critical factor for elderly recipients since they already have a diminished immune response. Also, physiological changes in elderly can interfere with the pharmacokinetics and pharmacodynamics of the immunosuppressive drugs causing their increased levels in blood and lower clearance. Long-term studies in elderly recipients are needed in order to establish adequate conditions for kidney transplantation and thus improve quality of life in this population, besides prolonging patient and graft survival.