In Brazil the incidence of DGF (delayed graft function) is high (60-70%) mainly due to an inadequate care of the donors and long cold ischemia time (CIT). This high incidence of DGF is associated to a longer hospitalization and poorer long-term graft survival. The use of perfusion machine (MP) as a preservation method is associated with a reduction of DGF. OBJECTIVES: The objective of this study is to evaluate the cost-effectiveness of MP use after long CIT in comparison to a cold storage (CS) in a kidney transplantation (KT) program. METHODS: A probabilistic decision tree was developed to compare MP versus CS. The structure of the model was populated by review of the literature and outcomes of KT in our center. The model estimated the incremental cost-effectiveness ratio (ICR) in terms of DGF. The costs analyzed were: transplant surgery; hospitalization stay; dialysis; hemotherapy; laboratory tests; preservation solution and kits. The values were from 09/2014. RESULTS: CONCLUSIONS: The use of the MP decreases DGF and hospital stay, and is cost-effective in terms of savings for DGF.