Background: Hyperlipidemia increases mortality and is common with kidney-disease. New-onset hyperlipidemia (NOHL) among patients wait-listed and after transplantation may impact costs and graft-survival of patients with kidney disease. Methods: Using the United States Renal Data System, we compared the costs to Medicare associated with or without NOHL in wait-listed patients in the second and first year pre-transplant and transplanted patients in the first and second year post-transplant. We also examined the impact on graft-survival of NOHL. Results: New onset hyperlipidemia was especially expensive when it occurred well before transplantation. When compared with individuals with no hyperlipidemia, patients with early onset hyperlipidemia cost an extra $15,228 in the two years before transplantation and an extra $14,673 in the two years following transplantation. As has been found in prior studies, patients without any NOHL had the worst graft survival rates. Conclusions: Although NOHL was associated with increased pre- and post-transplant costs, patients diagnosed with NOHL between the second year before and second year after transplantation experienced higher graft-survival rates than those without NOHL by 2-years post-transplantation. Prior studies attribute this relationship to inflammation and malnutrition, which result in lower cholesterol levels and worse outcomes.