*Purpose: The impact of failed allograft nephrectomy on the outcome of second kidney transplantation is not clear. We evaluated the effects of the first allograft nephrectomy on graft survival and renal function in second kidney transplantation.

*Methods: This study included 112 patients who received a second kidney transplantation from January 1989 to December 2017. We compared retrospectively the patients with and without first allograft nephrectomy.

*Results: Of the 112 patients, 94 patients (83.9%) received second kidney transplantation without first allograft nephrectomy (group A), and 18 patients (16.1%) with first allograft nephrectomy (group B). Of the 18 patients in the group B, 15 patients received allograft nephrectomy at the same time of second kidney transplantation and 3 patients received allograft nephrectomy before the day of second kidney transplantation. Patients in group B received second kidney transplantation in the ipsilateral iliac fossa. In the patient characteristics, there were no significant differences in the recipient and donor age, sex, and the number of cases of ABO-incompatibility. Crossmatch positive rate and preformed donor-specific antibodies positive rate was 21.3 % and 29.8 % in group A, and 11.1 % and 22.2 % in group B, respectively. There was no significant difference between the two groups in the incidence of acute antibody mediated rejection (A-ABMR) within 1 year (group A = 21 (22.3 %) vs. group B = 3 (16.7 %); p = 0.591). Also, there were no significant differences in the serum creatinine concentrations at 3 year (group A = 1.57 mg/dL vs. group B = 1.29 mg/dL; p = 0.426) and the estimated glomerular filtration rate (eGFR) at 3 year (group A = 44.4 ml/min/1.73 m² vs. group B = 52.7 ml/min/1.73 m²; p = 0.164). Although the 5-year graft survival rate was 86.2% in group A, there was no case of graft failure within the observation period in group B (p = 0.093).

*Conclusions: This study showed the failed allograft nephrectomy was not associated with the incidence of A-ABMR, graft survival, and function in second kidney transplantation. Allograft nephrectomy may not be a risk factor of increased second transplant failure in high immunological risk patients.

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