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Preemptive living donor kidney transplantation is the optimal treatment of end-stage renal disease with advantaged outcomes when it is compared to transplantation after starting chronic dialysis. However, these advantages are concerned to be affected by the lead-time and patients’ selection bias effects. We classified the potential biasing factors into intrinsic and extrinsic factors to the process of kidney transplantation and presented a different perspective in the effect of bias. We considered these factors as mere characteristics in the process preemptive living donor kidney transplantation which should be provided in accurate timing. Therefore, preemptive and non-preemptive kidney transplantations represent a single line of treatment which is implemented at different timings along the course of end-stage renal disease rather than two parallel lines. Hence, the perspective of lead-time bias could be ameliorated.

Keywords: End-stage renal disease; Kidney transplantation; Lead-time bias; Living donors; Pre-emptive kidney transplantation

Abbreviations: CKD: Chronic Kidney Disease; ESRD: End-Stage Renal Disease; KT: Kidney Transplantation; LDKT: Living Donor Kidney Transplantation; PKT: Pre-Emptive Kidney Transplantation

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