BACKGROUND Kidney transplantation is reported to save costs compared to maintenance dialysis. We analyzed the current actual costs of kidney transplantation compared to dialysis, and analyzed risk factors for higher costs after transplantation. MATERIAL AND METHODS Altogether, 338 kidney transplant recipients between 2009 and 2014 were included in this study. All individual-level cost data from specialized health care and data from all reimbursed medication and travel costs were acquired from official records. Cost data were compared before and after transplantation within the same patients starting from dialysis initiation and continued until the end of follow-up at the end of 2015. RESULTS Total annual costs were median 53 275 EUR per patient in dialysis, 59 583 EUR for the first post-transplantation year (P<0.001), and 12 045 EUR for the subsequent years (P<0.001 compared to dialysis). Median costs for specialized health care were 36 103 EUR/year per patient during dialysis, compared to median 51 640 EUR for the first post-transplantation year (P<0.001 compared to dialysis), whereas the median costs for the subsequent years declined to median 4895 EUR/year (P<0.001 compared to dialysis). The median annual costs for drug treatments and travel reimbursements during dialysis were higher compared to after transplantation (P<0.001). Delayed graft function and highly sensitized status were independent risk factor for higher costs during the first the post-transplantation year. CONCLUSIONS After the first posttransplant year the costs of a kidney transplant patient for the health care system are <1/3 of the costs seen during dialysis treatment. Delayed graft function and previous sensitization were associated with increased costs post-transplantation.