Preemptive kidney transplant

Preemptive kidney transplant

Mikel Prieto, M.D., discusses preemptive kidney transplant.

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A preemptive kidney transplant is a kidney transplant that takes place before dialysis begins. Dialysis is a treatment that removes extra fluid and waste from the body when the kidneys fail.

Most kidney transplants are done in people who are on dialysis because their kidneys can no longer clean their blood.

Preemptive kidney transplant is thought to be the best option for end-stage kidney disease. However, only about 2.5% of all kidney transplants in the U.S. are preemptive.

There are many reasons why the preemptive kidney transplant rate is low, such as:

  • Shortage of donor kidneys.
  • Late referrals to transplant centers.
  • Lack of access to care.
  • Delays in living donor evaluations.

Why it's done

A preemptive kidney transplant has many benefits, such as:

  • Lower risk that the body will reject the new kidney.
  • Longer life.
  • Better quality of life.
  • Lower treatment costs.
  • No need for dialysis and the dietary restrictions and health complications that come with it.

These benefits of preemptive kidney transplant are quite important for children and young adults with end-stage kidney disease.


Like any surgery, preemptive kidney transplant has risks. Two of the most common risks are:

  • Being exposed to the problems of surgery sooner than if you had waited to get a kidney transplant.
  • Possibly losing what kidney function you do have.

Though preemptive kidney transplants are often more successful than kidney transplants done after dialysis starts, a kidney transplant is not a cure. You need to take anti-rejection medicines for the rest of your life. These medicines also can have risks and side effects. Your healthcare team goes over all of the risks and side effects of transplant surgery.

How you prepare

First, you talk with members of your healthcare team. They can help you understand the transplant process and whether it's right for you.

Timing is critical. Talk with your care team about preemptive kidney transplant before your kidneys fail. If you have friends or family members who are willing to donate a kidney, they should get tested right away to see if they are a match. Waiting for a kidney from a deceased donor could mean you wait longer.

Choosing a transplant center

If your healthcare team recommends a preemptive kidney transplant, you will be referred to a transplant center for evaluation. You may be able to select a transplant center on your own or choose one from your insurance company's list of preferred centers.

Some things to consider when choosing a transplant center are:

  • The number and type of transplants performed each year.
  • Patient survival rates.
  • Insurance coverage and costs.
  • Whether the transplant center performs living donations, if you have a living donor.
  • Any support services available.

What you can expect

At the transplant center, your transplant team does several tests to decide if a preemptive kidney transplant is right for you. They'll consider many different factors, such as:

  • How well your kidneys are working.
  • Your overall health, including mental health.
  • Any chronic illnesses that might affect the success of the transplant.
  • Whether a donor kidney is available.
  • Your ability to follow your care team's orders and take anti-rejection medicines for the rest of your life.

If you are approved for a preemptive kidney transplant and a kidney is ready, the transplant surgery is scheduled. If a kidney is not ready, you may be put on a waiting list.


After your kidney transplant, you continue to see your healthcare team for regular checkups. Members of the care team make sure that your kidney is working like it should and that you are taking the right amount of anti-rejection medicine. Let your care team know right away if you are having any signs of rejection, such as:

  • Fever.
  • Less urine or urinating less often.
  • Swelling.
  • Weight gain.
  • Kidney pain.

It may take several weeks before you can go back to your typical activities. Most people can return to work after 6 to 8 weeks, but each person's recovery is different. Your recovery depends on many personal factors, such as any other medical conditions you have and how well your body responds to the new kidney.

March 28, 2024
  1. National Kidney Foundation. Accessed Nov. 20, 2023.
  2. Yishak AA, et al. Early referral, living donation, and preemptive kidney transplant. Transplantation proceedings. 2022; doi:10.1016/j.transproceed.2021.11.038.
  3. Brennan DC, et al., eds. Kidney transplantation in adults: Timing of transplantation and issues related to dialysis. Accessed Nov. 20, 2023.
  4. Warady BA, et al., eds. Overview of kidney replacement therapy (KRT) for children with chronic kidney disease. Accessed Nov. 20, 2023.
  5. Azegami T, et al. Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease: A systematic review and meta-analysis. Renal Failure. 2023; doi:10.1080/0886022X.2023.2169618.
  6. Rossi AP, et al., eds. Kidney transplantation in adults: Evaluation of the potential kidney transplant recipient. Accessed Nov. 20, 2023.
  7. National Kidney Foundation. Accessed Nov. 20, 2023.
  8. National Kidney Foundation. Accessed Nov. 20, 2023.
  9. National Kidney Foundation. Accessed Nov. 20, 2023.


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