Abstract Background and Aims Kidney re-transplantation (Re-KT) is associated with worse outcomes. Better results have been described when the KT is performed preemptive, before the patient returns to dialysis. However, the experience is limited so far. Method We performed a retrospective analysis of KT patients who received a preemptive KT (pRe-KT) in Andalusia between 1978-2023. A case-control study was carried out, choosing 2 controls for each case, adjusted for donor and recipient demographic characteristics (1 patient receiving a second non-preemptive KT [npRe-KT] and 1 patient receiving a first KT). We compared clinical characteristics and evolution between the 3 groups. Results During this period, 12217 KT recipients were registered in Andalusia. Of these, 1380 (11.3%) received at least a second KT. Eighty-two (0.059%) patients were pRe-KT recipients, all of them with a second KT. In the npRe-KT patients, there was a lower proportion of living donors than in the other groups (pRe-KT 30.4%, npRe-KT 6.3%, first KT 28.4%; p < 0.001). There were no differences nor in age neither in gender of donors and recipients. Graft survival in pRe-KT and first KT patients was similar and significantly better than in npRe-KT. Adjusting for donor type (living/deceased), npRe-KT remained as a risk factor. However, we observed no differences in patient survival between groups. Conclusion In pRe-KT patients, outcomes are significantly better than npRe-KT outcomes and similar to that of the first KT. These patients, when their clinical situation allows it, should be evaluated for inclusion on the waiting list before the definitive graft loss. Living donor KT should be actively encouraged in patients who are losing the functionality of their renal graft.