Renal transplantation (RT) is generally regarded as the ultimate treatment for patients with End Stage Renal Disease (ESRD) when this form of Renal Replacement Therapy (RRT) is appropriate. Over the last few years, pre-emptive renal transplantation (PRT) has gained wide acceptance. Renal transplantation services commenced in 1991 at our centre. Since 1998 we started to accept patients for PRT, 20 PRT were performed from 1998 – 2003(study group), which was compared with 44 patients who were on chronic dialysis and received first renal transplantation (control group). The two groups were well matched with respect to sex, age, HLA match, cold ischemic time, donor age, immunosuppression and year of transplantation. The incidence of delayed graft function occurred less frequently in the study group (10% Vs 13.6%). Acute rejection episode occurred in 10% in study group versus 11.3% in control group, with the need for ATG therapy in study group was less than control group. Mean serum creatinine at 1 month and 6 month was 1.33 mg/dl, 1.44 mg/dl respectively in study group compared to 1.39 mg/dl, 1.51 mg/dl in control group. One year, 2 years and 3 years graft survival were 100%, 100%, 95% in study group compared to 100%, 95.4%, and 95.4% in control group. On the other hand patient survival was comparable in the two groups. Pre-emptive renal transplantation is associated with lower serum creatinine level at 1-month and 6-months. Graft survival at 1-, 2-, and 3-years is better in PRT than in transplantation in chronic dialysis patients.