Our institution explored using allografts from donors with Hepatitis C virus (HCV) for elderly renal transplantation (RT). Thirteen HCV– elderly recipients were transplanted with HCV+ allografts (eD+/R–) between January 2003 and April 2009. Ninety HCV– elderly recipients of HCV– allografts (eD–/R–), eight HCV+ recipients of HCV+ allografts (D+/R+) and thirteen HCV+ recipients of HCV– allografts (D–/R+) were also transplanted. Median follow-up was 1.5 (range 0.8–5) years. Seven eD+/R– developed a positive HCV viral load and six had elevated liver transaminases with evidence of hepatitis on biopsy. Overall, eD+/R– survival was 46% while the eD–/R– survival was 85% ( P = 0.003). Seven eD+/R– died during follow-up. Causes included multi-organ failure and sepsis ( n = 4), cancer ( n = 1), failure-to-thrive ( n = 1) and surgical complications ( n = 1). One eD+/R– died from causes directly related to HCV infection. In conclusion, multiple eD+/R– quickly developed HCV-related liver disease and infections were a frequent cause of morbidity and mortality.