The Kidney-First Initiative: What Is the Current Status of Preemptive Transplantation?

John J. Friedewald*, Peter P. Reese

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

33 Scopus citations


Preemptive kidney transplant (PKT)-defined as transplant before dialysis-has numerous advantages as a treatment approach for patients with advanced renal disease. In the past 15 years, PKT has become more common and has been performed at higher levels of estimated glomerular filtration rate, particularly among recipients of live-donor transplants, among whom timing of transplantation is easier to control. However, recent studies have raised important new concerns about unintended consequences of early versus late PKT. In this article, we review the convincing evidence that PKT offers diverse advantages for patients, discuss potential problems that might emerge from PKT at higher levels of renal function, examine the feasibility of a " just-in-time" PKT strategy for transplant centers, and discuss whether a new kidney allocation system could affect rates of PKT.

Original languageEnglish (US)
Pages (from-to)252-256
Number of pages5
JournalAdvances in Chronic Kidney Disease
Issue number4
StatePublished - Jul 1 2012


  • Kidney
  • Preemptive
  • Transplantation

ASJC Scopus subject areas

  • Nephrology


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