*Purpose: The literature suggests a more significant persistence of hypertension following kidney transplantation alone than with kidney transplantation and native nephrectomy. This philosophy is in direct contradiction to current clinical practice. The purpose of this study was to evaluate differences in reduction of antihypertensive medication requirements in kidney transplant patients with single vs. bilateral native nephrectomies.

*Methods: We conducted a retrospective cohort study of kidney transplant patients who received a native nephrectomy before or after kidney transplantation from January 2012 through December 2016 grouped by single vs. bilateral native nephrectomy. The difference in continuous variables across compared groups was assessed using independent sample t-test and for binary outcomes using a chi-square test. All p-values were 2-sided and <0.05 was considered to be statistically significant.

*Results: We reviewed 389 records of kidney transplant patients and identified 33 cases of native nephrectomies before or after the transplant surgery (15 unilateral and 18 bilateral). There was no statistical difference in medical history, BMI, age, length of stay, discharge creatinine, pre-transplant mean blood pressure or pre-transplant antihypertensive requirements between unilateral or bilateral native nephrectomy kidney transplant patients. The decreased requirement of antihypertensive medications was statistically greater for kidney transplant patients with bilateral native nephrectomies vs. unilateral nephrectomies at 1-month (p=0.038 ), 6-months (p=0.010), 1-year (p=0.012) and 5-years (p=0.025) post kidney transplantation.

*Conclusions: Kidney transplant patients undergoing bilateral native nephrectomy require fewer antihypertensive medications post-transplantation. These findings suggest a role for bilateral over unilateral native nephrectomy when indicated in the kidney transplant patient. Further investigation of any potential inflammatory response from the retained non-functioning kidney is warranted.

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