Of five patients with hypernephroma who were maintained on hemodialysis after nephrectomy, four died with metastic disease after having been on hemodialysis for an average of 13.7 months (range 8 to 19). The fifth patient had no evidence of malignancy after 21 months of dialysis; he then received a renal allograft from his sister, and did well for 24 months before he developed liver metastasis. We believe hemodialysis is an appropriate mode of treating the renal failure of patients with hypernephroma after therapeutic nephrectomy. These patients may be considered for renal transplantation after a period of hemodialysis, and we suggest the currently recommended 12-month waiting period before transplantation be extended to 18 to 24 months. Use of living related donor renal allograft in these patients is questionable.