Long-term survival of kidneys from suboptimal donors is known to be not as good as that from optimal ones. However, the shortage of donors has led many transplant centers to consider accepting older donors with comorbidities. We analyzed 238 patients who received deceased donor renal transplants in the period 2000-2005. The recipients were matched to be no more than 15 years older or younger than the corresponding donors. Among them 125 received a single and 18 a double transplantation from donors considered marginal, according to UNOS criteria for expanded criteria donor (ECD). Most kidneys were evaluated with a pretransplant biopsy, using the scoring system introduced by Karpinski in 1999. The analysis indicated clearly better results in the non-ECD group: both patients and graft survival rates were 10% higher at 1, 2, and 3 years. However, the ECD group showed satisfactory outcomes, confirming the utility of this procedure. The long-term survival rates of single or double grafts from marginal donors are satisfactory, confirming the practice of allocating kidneys after a preimplantation histological evaluation, allowing expansion of the donor pool and providing older patients access to the waiting lists.