Aims: There has been a significant increase in the utilization of both older live donor (OLD) and expanded criteria (ECD) deceased donor (DD) kidneys for transplantation. Although it is well established that DD-ECD transplants are associated with inferior graft outcomes, transplant outcomes of OLD kidneys remain unclear. Methods: Using the Australia and New Zealand Dialysis and Transplant Registry, primary LD and DD renal transplant recipients in Australia and New Zealand between 1997 and 2009 were analysed. Donor type was categorized into 6 groups - DD-standard criteria with ischaemic time < 12 hours (DD-SCD < 12h), DD-SCD312h, DD-ECD < 12h, DD-ECD 312h, LD-SCD and OLD. DD-ECD were defined as donor age >60 years or age >50 years with 2 of 3 criteria of hypertension, cerebrovascular disease-associated death and terminal creatinine of >133mmol/L, whereas OLD were defined as the presence of donor hypertension or donor age >60 years. Multiple organ grafts and pre-emptive transplants were excluded. Confounders including donor (age, gender), recipient (age, gender, body mass index, co-morbidities, cause of end-stage kidney disease, race) and transplant (HLA-mismatches, panel reactive antibodies, transplant era and state/country) associated variables were included. Outcomes assessed included overall graft failure, death-censored graft failure (DCGF) and recipient survival. Results: Of the 6317 recipients included, the number (%) of recipients in each group was 877 (13.8%) in DD-SCD < 12h, 2105 (33.0%) in DD-SCD 312h, 277 (4.3%) in DD-ECD < 12h, 857 (13.4%) in DD-ECD 312h, 1832 (28.7%) in LD-SCD and 369 (5.8%) in OLD groups. Compared to DD-SCD < 12h, DD-ECD < 12h, DD-ECD 312h and OLD grafts were associated with a significantly higher risk of overall graft failure in the unadjusted and adjusted models (adjusted hazard ratio [AHR] 1.43, 95%CI 1.07, 1.91; AHR 1.77, 95%CI 1.45, 2.16; and AHR 1.35, 95%CI 1.01, 1.82 respectively) and DCGF (HR 1.90, 95%CI 1.22, 2.95; HR 2.46, 95%CI 1.79, 3.37; and HR 1.71, 95%CI 1.11, 2.65 respectively). Compared to DD-SCD < 12h, LD-SCD was associated with a significantly lower risk of overall graft failure (HR 0.77, 95%CI 0.64, 0.94) and recipient death (HR 0.60, 95%CI 0.46, 0.77) in the unadjusted model but not significant in the adjusted model (HR 0.90, 95%CI 0.73, 1.10 and HR 0.85, 95%CI 0.64, 2.22 respectively). Conclusion: With the continuing shortage of organ donors and increasing acceptance of marginal kidneys, the finding of inferior graft outcome of both DD-ECD and OLD grafts compared to DD-SCD and LD-SCD grafts should be carefully considered in the decision-making process for any potential transplant recipient.