Abstract: Objective To investigate the effects of age on acute rejection (AR) in living donor kidney transplantation (LDKT) recipients. Methods This study was performed in 327 donor–recipient pairs of kidney transplantation in our center from January 2006 to December 2013. Donors with age over than 55 years were defined as elder donors, while recipients with age younger than 30 years were defined as young recipients. Clinical baseline data about donors and recipients were recorded and patients were followed up at 1, 3, 6, 12, 24, 36, 48, 60 months after transplantation with medical examination, medical history examination, laboratory examination, AR occurrence examination. The risk factors that might be associated with AR were analyzed using both univariate analysis and Cox proportional hazards regression modeling. Results The follow-up period of AR and without AR group was (35.9±13.2) months and (36.3±15.4) months, respectively. The incidence of AR in recipients within 3 months after transplantation was 7.3% (24/327). The serum creatinine level and the incidence of proteinuria in AR group were higher than without AR group in the same period. Multivariate analysis revealed that young recipient who received older donor graft was an independent risk factor for AR with the relative risk (RR) of 3.67 (95% CI: 2.61- 4.58, P=0.002). Conclusion The independent risk factor of AR is young recipients who receive older donor graft.