OBJECTIVES: Aim of the present study was to evaluate, through the analysis of administrative databases, healthcare resource consumption and costs in charge to the Regional Health Service (RHS) for patients receiving kidney transplantation. METHODS: All data recorded in the regional administrative databases regarding subjects resident in Lombardy (one of the Italian Regions, with about 9,700,000 inhabitants) who received kidney transplantation in 2011 were extracted. Direct healthcare costs in charge to the RHS for these subjects for the 12 months preceding and following transplantation were estimated (drugs, hospitalizations, diagnostic/therapeutic procedures). RESULTS: In 2011, 276 subjects received kidney transplantation, 268 of which survived for the following 12 months. Administrative data were available for 264 of these subjects (67.8% males, mean age 49.4). Among those patients who survived one year after transplantation, the per-patient yearly cost before transplantation amounted to 36,746€ (11.6% for drugs, 81.2% for diagnostic/therapeutic procedures and 7.2% for hospitalizations). Dialysis accounted for 91% of all costs for diagnostic/therapeutic procedures.  In the year following transplantation, the per-patient cost amounted to 43,806€ (25.8% for drugs, 15.8% for diagnostic/therapeutic procedures and 58.4% for hospitalizations). The average per-patient cost of transplantation intervention was 21,183€ (82.7% of total cost of hospitalizations). The average cost of the last year of life of those patients who died within 12 months after transplantation was 79,362€/patient (68.1% of which for hospitalizations). CONCLUSIONS: Kidney transplantation substantially changes the composition of costs associated to patients affected by end stage renal disease, dramatically reducing the costs of diagnostic/therapeutic procedures and increasing drug expenditure. When evaluating the increase in hospitalization costs, the incidence of transplantation expenditure should be considered. Speculatively, it should be expected that in the following years the per-patient cost would decrease thanks to savings following the reduction in dialysis costs.