OBJECTIVES: Solid organ transplants (SOT) are expensive, and much of the cost is incurred in the first 3 months of care to cover pre-transplant, procurement and procedural costs, which can reach >$200,000 per transplant, and higher with complications. Delayed graft function (DGF) is a complication affecting 20-40% of kidney transplants and is believed to result from ischemic reperfusion injury (IRI).  The objective of this analysis is to quantify the additional charges and length of stay (LOS) associated with complications such as DGF.  METHODS: Using 2008 Health Care Utilization Project (HCUP) data, individuals with a recorded transplant procedure (ICD-9 CM: 07.94 (thymus); 33.50-33.52 (lung); 336 (heart-lung); 41.94 (spleen); 46.97 (intestine); 50.51 and 50.59 (liver); 52.80-52.83 (pancreas); 65.92 (ovary) were identified. The mean hospital charges for individuals with and without a recorded complication diagnosis (ICD-9 CM 996.80-996.89 and additionally for kidney patients a recorded dialysis procedure 39.95) were compared using student’s t-test.   RESULTS:  The number of SOTs (and complications) for each organ type were: 4119 (21%) kidney, 1677 (17%) liver, 485 (28%) heart, and 264 (35%) lung. Heart-lung, intestine, pancreas and spleen were excluded from the analysis with <100 transplants each. Kidney and liver transplant patients with complications had significantly higher mean hospital charges and LOS than those without the complications: kidney ($209,503 vs. $160,997, p<0.001) and (7.0 days vs. 11.1 days, p<0.001), and liver ($460,351 vs. $340,296, p<0.001) and (21.0 days vs. 31.6 days). Heart and Lung transplant patients had higher charges than those without the complication diagnosis. The difference was not statistically significant.  CONCLUSIONS:  Our results demonstrate that having to treat complications of transplants adds significantly to the cost of hospital care and LOS.  There is a need for a novel agent that may reduce IRI.  Proactive management of patients with risk of IRI may confer substantial savings to hospitals.