*Purpose: There is no consensus about optimal timing for native nephrectomy according to the primary indication of kidney transplantation (KTx) especially in pediatric population and with this single center study, we aimed to determine the indications, timing, techniques and outcomes of native nephrectomy in pediatric KTx patients.

*Methods: Children who underwent native nephrectomy and KTx were reviewed retrospectively in terms of patient characteristics, indications, timing (simultaneous native nephrectomy and transplantation, staged native nephrectomy before or after KTx) and techniques of native nephrectomy along with the postoperative complications and, patient and graft survivals in a single center.

*Results: Between July 2008 and November 2021, 70 children underwent isolated KTx, and all allografts were from live donors. Overall patient and graft survivals are 98.5% and 97.1% respectively. We further analyzed 21 patients with native nephrectomies. Main indications for nephrectomies were complications related to congenital anomalies of kidney and urinary tract (n=14, 66%) including posterior urethral valve (n=6), infantile polycystic kidney disease (IPCKD, n=4), ureterovesical junction obstruction with dysplastic kidney (n=3). Congenital nephrotic syndrome was the cause in 3 patients. Median recipient age was 3.2 years (range 0.6-17.4 years) with median body weight of 10.7 kg (range 6-41 kg). The body weight was under 15 kg in 15 patients (71%). Only one 10-month-old, 6 kg patient with IPCKD had staged nephrectomy prior to the transplantation and rest of the nephrectomies were simultaneous. Transabdominal approach was the choice in 16 patients including staged one and the rest were performed by retroperitoneal approach with extended hockey stick incision. All patients are alive with well-functioning allografts. The post-operative surgical complications were intestinal obstruction (n=2) and evisceration (n=1) which required laparotomy.

*Conclusions: Native nephrectomy at time of kidney transplantation is a safe procedure with manageable morbidities especially in low body weight children. Living donor KTx allows for excellent timing and preparation resulting in single procedure with simultaneous method.

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