Elderly patients are the fastest growing group requiring renal transplantation. This study investigates whether transplantation is worthwhile in the elderly and whether there is evidence supporting an age limit for transplantation. One thousand ninety-five adults transplanted in Scotland between 1 January 1989 and 31 December 1999 were followed up to 11 years. Sociodemographic, comorbidity and transplant data were obtained from the national databases and patient's notes. Patient and graft survival, risk and causes of graft failure and patient death were compared between four age groups (18-49, 50-59, 60-64 and >65). All groups had similar gender, social deprivation and renal disease distribution. The incidence of comorbidity increased with age. The groups had comparable HLA matching, but patients aged 18-49 years received transplants from younger donors and with shorter cold ischaemic times. Younger patients had more acute rejection and less delayed graft function. Older patients had a higher incidence of death with functioning graft. Patients over 65 years had an almost dialysis-free remaining life, while the graft half-life was significantly shorter than patient half-life in the youngest group. Transplantation in elderly recipients is worthwhile despite a higher comorbidity. Careful selection rather than a fixed age limit should be used to ensure a satisfactory graft and patient survival.