*Purpose: We describe relationships between total medical costs in the first year following kidney transplant with overall renal function as measured by: 1) estimated glomerular filtration rate (eGFR) at different time point during the first year, and; 2) early graft failure.

*Methods: The United States Renal Data System was used to identify adults receiving single-organ deceased donor kidney transplants 2012-2015. Recipients without Medicare as primary payer were excluded. Costs derived from Parts A and B claims including inpatient, emergency, outpatient, and skilled nursing facility costs. eGFRs were available at discharge, 6-months, and 12 months. Thus, eGFR:Cost relationships are described for several month-based time periods post-discharge: 0-3, 3-6, 6-12, and 3-12. For recipients with graft failure a time-history of medical costs was constructed with failure as the index date. Descriptive analyses were conducted.

*Results: For those without graft failure in the first year, total medical costs exhibit strong trends with eGFR in the post-discharge period. In the 3-6 months post-discharge, recipients with 6-month eGFRs of 30-59 mL/min/1.73m² have total costs 48% lower than those with <30 mL/min/1.73m². Both 6- and 12-month eGFRs correlate well with costs from 3 to 12 months post-discharge. Recipients with graft failure in the first year, monthly costs begin to rise 3-4 months prior to failure, with a spike of over $38,000 during the month of failure. Costs appear to stabilize 2-3 months post failure suggesting a months-long failure process.

*Conclusions: Total medical costs in the first year post-transplant are strongly correlated with eGFR at various times post-discharge. Time histories of resource utilization indicate that graft failure in the first year is a very expensive process unfolding over several months.

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