Background: Native nephrectomy prior to kidney transplantation is performed on pediatric patients for congenital anomalies, proteinuria, intractable hypertension, malignancy and chronic infection. The impact of nephrectomy regardless of the indication on hypertension post-transplant is poorly studied in large populations and is the purpose of this study.

Methods: We retrospectively evaluated 129 pediatric kidney transplant patients between 2007-2011 at Lucile Packard Children’s Hospital at Stanford University. Patients were categorized into three groups, no nephrectomy, unilateral nephrectomy and bilateral nephrectomy. All indications for nephrectomy were included. Data was gathered including reasons for transplant, age at transplant, time on dialysis, donor type and graft function. Hypertensive medications before and after transplant and one year following transplant were examined and statistically analyzed.

Results: Of the 129 patients transplanted there were 38 unilateral nephrectomies, 32 bilateral nephrectomies and 59 patients without nephrectomies. There was a statistically significant difference in the percentage of patients in the bilateral nephrectomy group off antihypertensive medication 1 year after transplant compared to both the unilateral nephrectomy and no nephrectomy groups (p<0.0005). Unilateral nephrectomy also showed a statistically significant difference when compared to no nephrectomy (p<0.05). Although patients without nephrectomy had 76% on hypertensives before transplant compared to 60% and 63% in the other two groups the number of patients that went from requiring mediation to being medication free was statistical different in the bilateral nephrectomy group and more bilateral nephrectomy patients had multiple antihypertensive medications pre-transplant as well.

Conclusions: Bilateral nephrectomies improved hypertension control and reduce the need for antihypertensives from 60% to 9% post-transplant when compared to patients with both native kidneys. Bilateral nephrectomies should be considered with appropriate indications including intractable hypertension. This may be essential in this patient population where compliance with medication can be a challenge and hypertension at a young age can have impact on cardiovascular health through a lifetime.

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