Eurotransplant offers a Senior Program to extend the donor pool for renal transplantation. The study comprised 14 patients of the ET Senior ("Old For Old") Program. Kidneys from five cadaveric donors were transplanted in pairs to ten recipients with a difference in cold ischemia time (CIT) of >4 h, and grouped according to CIT (group 1: patients that underwent transplantation first; group 2: patients that underwent transplantation second). CIT was shorter (5.5+/-2.0 h vs. 11.7+/-3.1 h, P<0.01), and the first day diuresis was higher (287.4 ml/h vs. 134.8 ml/h, P<0.05) in group 1 than in group 2. No patient in group 1 required dialysis, 3/5 patients in group 2. Rejection episodes occured more often in group 2 (5/5 vs. 3/5), and the hospital stay tended to be shorter in group 1 (33.0 days (27-43) vs. 54.2 days (27-112)). Our study confirms the positive effect of ultra-short CIT on early graft function in marginal donors, despite overall short CIT. The increase in delayed graft function (DGF) may lead to an extended hospital stay and dialysis requirements. Efforts to realize simultaneous transplantation in two recipients seem necessary to optimize results.