OBJECTIVES: In 2015, according to Brazilian Transplant Register, there were 19.440 patients on kidney waiting list. Kidney transplantation (KT) remains the most effective treatment for end stage renal disease. However, there are few studies about cost in transplant in Brazil and decided to conduct a cost-effectiveness analysis of our KT program METHODS:  We conducted a retrospective analysis where we included all patients that underwent KT in 2015. We collected data about costs per patient including the pre transplant phase (eligibility evaluation for the transplant, listing and outpatient follow up), the transplant and post-transplant phases, until 1 year of follow up. The unit costs of materials and medicines correspond to the average direct costs of acquisition. For the survival analysis we used Cox model, including all KT performed from 2002 to 2016. The values of GDP per capta and dollar exchange rate were the ones from 12/2015, being U$ 6.963,94 and BRL 3,91, respectively. Cost-effective therapy was defined here when the cost for each year of life saved was lower than 3x GDP (U$20,891.82). RESULTS:  In 2015, 95 renal transplants were carried out. The mean and median costs of KT were U$ 37,329.50 and U$ 29.375,29, respectively. For survival analysis 967 KT were included. The calculated survival was 14.3 years. The cost per year of life saved was U$2,606.81. Considering the limit of 3x of GDP, the KT was considered a cost-effective therapy and 5,3 years of lifespan would be necessary for the treatment to be paid off. There would still be 9 years for the recipient to produce wealth, generating U$62,675.46 during that time span. CONCLUSIONS:  The KT was considered cost-effective once it has generated enough survival results to cover the transplant costs and still generate wealth for the country.