Currently,　the　growing　number　of　end-stage　renal　disease　patients　in　developing　countries　consumes　a　greater　proportion　of　healthcare　budget,　and　increasing　attention　is　being　focused　on　the　cost-effectiveness　of　the　procedure.　We　aimed　to　assess　the　cost-effectiveness　of　living-related　renal　transplantation　(RTx)　as　compared　with　that　for　hemodialysis　(HD)　and　identify　medical　factors　associated　with　charges　for　RTx　in　northwestern　China.　This　study　was　a　retrospective　analysis　of　372　patients　on　regular　HD　and　122　living-related　kidney　transplant　recipients　on　regular　follow-up　for　at　least　3　years　in　northwestern　China.　All　data　on　charges　included　HD　procedure,　RTx　procedure,　the　cost　for　donor　operation,　immunosuppression,　and　follow-up　medicare.　The　average　annual　cost　to　all　patients　on　HD　and　kidney　recipients　during　the　first　3　years　after　RTx　was　$14482/$31027,　$13502/$11038,　and　$13382/$10243,　respectively.　The　three　variables　were　found　to　be　significant　in　predicting　increased　costs　for　RTx:　diltiazem　administration,　acute　rejection　and　infection　complications.　We　concluded　that　from　the　second　year　on,　RTx　in　China　was　more　effective　and　less　costly　than　dialysis　treatment,　although　recipients　without　diltiazem　administration　and　with　acute　rejection　or　infection　proved　costlier　during　the　first　year　after　transplantation.　©　2012　The　Editorial　Board　of　Journal　of　Medical　Colleges　of　PLA.　E-edition　published　by　Elsevier　(Singapore)　Pte　Ltd.