Isolated cases or small series of orthotopic liver transplantation (OLT) with grafts from donors older than 80 years have been reported, but the long-term outcome of patients receiving livers from extremely old donors is unknown. From 1998 to 2003, we performed 17 OLTs with donors older than 80 years (median, 82 years; range, 80 to 87 years). No deaths occurred in the early postoperative period. We analyzed the outcome in 12 patients with a follow-up longer than 1 year. Hepatic insufficiency was caused by hepatitis C virus (HCV)-related cirrhosis in five cases (42%) and non-HCV-related diseases in seven cases (58%). All donors had normal liver function, hemodynamic stability, and no parenchymal alterations. OLT was uneventful in all cases. Median follow-up was 30.3 months (range, 17 to 42 months). No late vascular complications occurred. One patient (8.3%) died 3 years after OLT for causes unrelated to hepatic dysfunction. Two- and 3-year actuarial survival rates were 100% and 75%, respectively. All HCV-positive (HCV(+)) patients developed hepatitis recurrence (after 2, 3, 4, 5, and 22 months) requiring antiviral treatment in 3 patients and leading to graft cirrhosis in 1 patient. Non-HCV(+) patients had well-preserved liver function throughout the observation period. At the end of follow-up, we observed no clinical hepatic decompensation in the entire group and biochemical signs of recurrent disease in 3 patients. Use of grafts for OLT from donors older than 80 years is safe because of their potentially normal functional recovery. A selection among available organs is mandatory to minimize other risk factors for poor outcome. Long-term patient and graft survival seem to be achievable, but the high rate and rapidity of HCV reinfection remain a major concern for HCV(+) patients.