Kidney transplantation is the most preferred treatment for end-stage renal disease because it improves not only the patient's survival compared with dialysis, but also the quality of life. Preemptive transplantation is transplantation performed prior to the initiation of renal dialysis. Recent observational studies have shown increased patient and graft survival with preemptive transplantation, compared to patients receiving transplantation after the initiation of dialysis. Preemptive simultaneous pancreas and kidney transplantation in type 1 diabetic recipients has also been shown to improve patient survival. These results indicate the importance of early referral of patients who have chronic kidney disease to nephrologists and transplant centers.