Patients with renal failure, awaiting kidney transplantation or who have undergone transplantation, can be affected by two common diseases that require a nephrectomy. Autosomal dominant polycystic kidney disease (ADPKD) is one of the most frequent causes of renal failure. Nephrectomy of the polycystic kidney is not routinely recommended, but it is necessary in the case of complications. It can be performed in selected cases before, during or after the transplantation, or even pre-emptively, as described by several authors. Currently, there is still no consensus on the right timing, and the choice should be tailored to the patient. One of the most fearsome complications of kidney transplantation is graft failure. In these cases, it is still debated whether allograft nephrectomy should always be performed. Allograft nephrectomy is mandatory in cases of hyperacute or acute rejection or other types of acute complications, while it can be deferred when a chronic rejection is present. It can be performed with different surgical techniques. Every procedure has various risks and the choice is made considering the graft implantation, the time from the transplantation and the surgeon’s inclination. There is still no clear superiority of one technique over the others.