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Objective: The management of a failed renal allograft is controversial. Transplant nephrectomy can lead to anti-HLA antibody formation (allo-sensitization). We evaluated the effect of transplant nephrectomy on allo-sensitization and the rate of subsequent transplantation. Design: Retrospective review of data from prospectively collected institutional and UNOS databases of kidney transplant recipients from 1997-2012. Setting: Single, academic transplant unit. Patients: 933 renal transplants were performed during the study period out of which 183 failed (19.6%). Patients with failed transplants were divided into two groups; transplant nephrectomy for-cause (TN=53/172) and those who retained allograft (RA=119/172). Main Outcome Measure(s): Panel Reactive Antibody (PRA) values of patients who were re-listed were collected at selected time points after graft failure. Results: Both groups were similar in respect to age at transplantation, race, gender, transplant type (living vs. deceased), etiology of ESRD and time to graft failure (p= NS). No differences in co-morbidities were observed except for more patients with IDDM in the RA group (47.4% vs. 26.4%; p= 0.0097). TN group demonstrated a significant increase in PRA values immediately following TN (15 % vs. 22 %; p= 0.027). Patients with a failed allograft did not have significant change in PRA values (p= 0.051) over 1 year post-failure. 5/28 (17%) patients in TN group became highly sensitized (PRA>60) compared to 3/52 (5.7%) in FA group (p=0.08). Re-transplantation rates were similar at 4 years from graft failure in both groups (TN= 9/53, FA= 20/119; p=0.30). Conclusions: Although a mild increase in PRA was observed immediately following transplant nephrectomy, TN does not decrease the opportunity for re-transplantation and should be performed for-cause.