Among several renal replacement therapies available for ESRD , renal transplantation is the best option. Patient usually undergo renal transplantation after a variable period of pretransplant dialysis (PTD). For eligible patients when organs are available, the dialysis stage could be bypassed, namely, pre-emptive transplantation (PTX). Graft and patient survival has been compared in PTX and PTD in multiple studies and comparable (or evevn better) outcome have been reported for PTX. PTX is more cost effective than PTD and therefore a better choice, especially in developing countries. Preemptive kidney transplantation was begun in our centers in 1992. in this study 600 patients who underwent kidney transplantation from living donors over the last 14 years , were surveyed retrospectively. Of these patient 300 received PTX (Preemptive renal transplantation), 170 male and 130 female , and 300 underwent renal transplantation after at least 4 months of hemodialysis (PTD), 172 male and 128 female. Of all acute rejection 7.2% in PTX and 3% in PTD were biopsy proven. All patients were included in this study (300 cases) compared with 3oo subjects who underwent renal transplantation after a variable duration of hemodialysis, lasting at least 4 month. The Patients were follow up in a variable duration. (from 0.5 month till 96 month) from 300 cases 92% were active (Cr<2.5) in PTX groups and 92.1% in PTD groups over their following up. One, 2-, 3- and 4 year graft survival were 94% (in 12.6 month), 89% (in 25month), 86% (in 39 month) and 81% (in 53 month) respectively in PTX and 95% (in 12.5 month), 94% (in 23.6 month), 92% (in 3606 month), 89% (in 54 month) in PTD groups. At the end of first, second, third and fourth year after transplantation, patient survival were; 98% (in 8 month), 97% (in 25 month), 95% (in33 month) in PTX groups and 97% (in 33 month), 94% (in73 month) in PTD groups. These differences for patient survival statistically were not significant (P=0.4, 0.62, 0.62, 0.8) and for graft survival (P=0.1, 0.3, 0.4, 0.4). The rejection episodes in both the groups were the same. The results of this study demonstrate that patient survival at 1, 2, 3, 4 years post transplant were similar in two groups. 1-, 2-, 3- and 4- graft survival rates had not significant differences. These finding are consistent with results of previous studies, but it differ erom results of our past study (3 years ago, with 313 patients, 127 PTX and 186 PTD groups) that showed better outcome in PTX groups (about 3-years graft survival although it was not significant). In summary, despite similar patient survival in the PTX and PTD groups, PTX eliminated hemodialysis and arterio venous fistula formation. Thus, we recommend PTX as a better choice for transplantation when impossible. We continue our study with further cases and over the longer follow uo period.