We analyze and describe the epidemiology, characteristics and outcome of patients who underwent preemptive kidney transplants from living donors. The outcome of preemptive transplants from deceased donors and that of living donor transplants in patients who have started dialysis are often compared with the outcome of preemptive transplants from living donors. The causes of the better outcome of preemptive kidney transplants are analyzed here. We have examined data from large registries including the Collaborative Transplant Study, USRDS and ANZDATA registry as well as the results of single-center studies and data from developing countries. Overall, preemptive transplantation is more frequently performed with living donors. Recipients are often younger and have fewer vascular comorbidities. Also late referrals are less frequent with preemptive kidney transplantation. The data described by different studies may be discordant, but this is caused by different factors linked to the studies, as well as donor type, recipient age and residual renal function at transplant. Preemptive transplant usually has a better outcome because of the avoidance of dialysis-related comorbidities. Preemptive transplant is associated with less delayed graft function, fewer acute rejections, and better graft and patient survival rates.