OBJECTIVES: At present, expanded criteria donors suppose up to 40-50 % of the renal transplant. The aim was to evaluate cost-utility difference between standard criteria donors (SCD) versus expanded criteria donors (ECD) at the first year of kidney transplant. METHODS: Patients were collected in the waiting-list for renal transplant in our region from January 1, 2003 to December 31, 2005. Clinical and demographic variables, transplant costs and EQ-5D tariff, as a generic perceived state of health (PSH) profile, were analyzed. RESULTS: A total of 131 patients were included in the waiting-list and 80% received a kidney transplant, 41% were ECD. Sixty percent were men. The age difference between ECD, SCD and not transplanted was significant (p=0.000).The mean time in waiting-list (15months) and cold ischemia time (14 hours) were the same for both groups. There were no differences in clinical variables. The PSH improvement in ECD at year was significant (p=0.022), whereas for the SCD not. There were differences in incomes (p=0.041) between groups. The survival at first year was 100% for SCD and 97.7% for ECD. At year, mean cost for SCD transplant was €54,343/year versus €59.13€/year for ECD (no significant). The difference in QALYs between transplanted ones and not-transplanted was significant (p=0.019). The utility was: 0.8096 QALYs for SCD, 0.7786 for ECD and 0.6838 for not transplanted. Cost-utility analysis showed that one QALY in SCD cost €67.27€, versus €79.95€/QALY of ECD and €80.43€/QALY of not transplanted in waiting list. CONCLUSIONS:There were no clinical differences and not in PSH at the first transplant year between SCD and ECD, but there were in age and what it bears. The differences in terms of cost-utility, in the first year, between ECD and not transplanted were small. However, the differences could be important in long term, because after the first year the costs have an important decrease. Therefore, it seems that ECD transplant have a good results in health and costs.