It is not clear whether in old people with end-stage renal disease kidney transplantation is superior to dialysis therapy. We compared mortality rates between kidney transplant recipients (KTRs) and the general population across different age categories. We also examined patient and allograft survival in 15667 elderly KTRs (65-<90yr old, 36% female) within three age subgroups (65-<70, 70-<75, and ≥75yr). The rise in the relative risk of death in older age groups was substantially less in KTRs than in the general population, that is, 1.8 and 2.0 vs. 21.4 and 76.6 in those aged 65-<75 and ≥75yr, respectively, compared with 15- to <65-yr-old people (reference group). In 65- to <70-yr-old KTRs, obesity (BMI>30kg/m(2) ) was associated with 19% higher risk of graft failure (HR: 1.19 [1.07-1.33], p=0.002). Diabetes was a predictor of worse patient survival in all age groups but poorer allograft outcome in the youngest age group (65-<70yr old) only. None of the examined risk factors affected allograft outcome in the oldest group (≥75yr old) although there was a 49% lower trend of graft failure in very old Hispanic recipients (HR: 0.51 [0.26-1.01], p=0.05). Kidney transplantation may attenuate the age-associated increase in mortality, and its superior survival gain is most prominent in the oldest recipients (≥75yr old). The potential protective effect of kidney transplantation on longevity in the elderly deserves further investigation.