Table 5.

Studies examining effectiveness of native nephrectomy and blood pressure control in kidney transplant recipients.

References	n/age	Exposure	Outcomes	Other outcomes	Conclusions
Vanrenterghem et al. (216)	707 first DDRT on CsA	Group I: 264 patients with post-transplant bilateral native nephrectomy Group II: 443 patients with non-nephrectomy	Proportion of patients requiring antihypertensive medication was lesser in group I compared to group II at 1-year post-KTx [45.3 vs. 65.8% (P < 0.0001)]. Group I had lower DBP than group II (83 ± 10 vs. 87 ± 25; P < 0.02). Lower proportion of patients with Hb >17 g/dl in group I compared to group II [6 (2.3%) vs. 44 (9.9%); P < 0.0001] during the first year post-KTx. The directions of these associations were not different 5 years after transplantation.	Patient and graft survivals and renal allograft function were not different between two groups. Proportion of acute rejection during the first year post-KTx was lower in group I than that in group II [0.62 ± 0.88 vs. 0.78 ± 1.02 (P = 0.0285)]	Posit-transplant arterial HTN and erythrocytosis could be controlled by post-transplant bilateral native nephrectomy.
Lerman et al. (217)	5 patients 2 with HTN or FSGS had KTx-−3 with DM had KPx/age range 49–69 years old	Post-transplant laparoscopic bilateral native nephrectomy	↓MAP in all 5 patients at 3–6 months post nephrectomy. ↓The number of antihypertensive medications in 4 patients.	Renal allograft functions - Stable in 3 patients- ↓ in 2 patients.	Benefit of nephrectomy (e.g., improved BP, decreased or no increased number antihypertensive medications, and stable renal allograft function) in 3 patients with a lower baseline creatinine at the time of bilateral native nephrectomy.
Iino et al. (218)	50 ADPKD patients with KTx	Group I: 24 patients with no native nephrectomy, Group II: 7 patients with pre-transplant unilateral native nephrectomy Group III: 19 patients with pre-transplant bilateral native nephrectomy	Proportions of HTN 6 months post-KTx compared to those pre-KTx were lower in group III, but higher in group I and II (the hypertension rate before and within 6 months after transplantation was I-70.8 vs. 82.6%, II-71.4 vs. 80%, and III-78.9 vs. 61.1%, respectively). Prevalence of HTN after 6 months post-KTx was highest in group I followed by group III and then group II [HTN after 6 months was more prevalent in I group (95.5%) than in II (40%)], III (64.7%) groups (p = 0.008)	Graft failure and proteinuria were not significant differences among three groups.	ADPKD patients post-KTx without native nephrectomy had higher prevalence of post-Tx HTN than those with pre-KTx unilateral or bilateral native nephrectomy.
Shumate et al. (219)	118 ADPKD patients undergoing KTx from 2003 to 2013/mean age 53.6 ± 10.3 years	Group I: 54 patients with KTx alone Group II: 32 patients with simultaneous ipsilateral native nephrectomy-KTx Group III: 32 patients with simultaneous ipsilateral native nephrectomy-KTx and delayed contralateral native nephrectomy	The quantity and daily dose of antihypertensive medications were lower in group II compared to group I at 12, 24, and 36 months post-KTx. Mean number of antihypertensive medications from post-ipsilateral nephrectomy to 12 months post-contralateral nephrectomy was lower in group III compared to non-nephrectomy group.		Quantity and defined daily dose of antihypertensive medications were significant lower in simultaneous ipsilateral native nephrectomy-KTx and even lower in delayed contralateral native nephrectomy.
Jo et al. (220)	42 ADPKD patients with KTx/mean age: Group I 50.2 ± 10.4 years vs. Group II 52.4 ± 8.6 years	Group I: 26 ADPKD with simultaneous native nephrectomy-KTx Group II: 16 ADPKD patients with KTx-alone	Group I required less antihypertensive medications compared to group II at 1, 3, 6, and 12 months post-KTx.	Group I had significant higher proportion of peri-operative hypotension compared to group II (69.2 vs. 37.5%, p-value 0.045).	Patient and renal allograft survivals and renal allograft function were not different between two groups.
Obremska et al. (221)	32 patients with pretransplant bilateral native nephrectomy/mean age 51.72 ± 14.46 vs. 51.94 ± 12.97 (control)	Group I (study group): 32 patients with pretransplant bilateral native nephrectomy Group II (control group): healthy patients Median time to follow-up: - Group I 95 months (54.5, 115.5) -Group II 91 months (57.5–132.4).	Group I had lower SBP and the number of antihypertensive medications compared to group II.	Group I had lower LVMI, LAVI, and left ventricular mass evaluated by CMR. Group I had milder LVDD than group II.

ADPKD, autosomal dominant polycystic kidney disease; CMR, cardiac magnetic resonance; CsA, cyclosporine A; DBP, diastolic blood pressure; Hb, hemoglobin; KPx, kidney-pancreas transplantation; KTx, kidney transplantation; LAVI, left atrial volume index; LVDD, left ventricular diastolic dysfunction; LVMI, left ventricular mass index; MAP, mean arterial pressure.