[Pregnancy after kidney transplantation]

Renal transplantation is invariably accompanied by improvement in reproductive function. The possibility of conception in women of childbearing age emphasises the need for sensible counselling. Most authorities advise a delay of about two years post-transplantation. This appears to be good advice, because by then the patient will have recovered from the major surgical sequelae, renal function will have become stabilized with a very high probability of allograft survival at five years and immunosuppression will also be at a maintenance level. Renal function should be stable with a S-creatinine less than 130 micromoles/l. About 40% of all conceptions do not proceed beyond the first trimester. The overall complication rate in pregnancy continuing beyond the first trimester is 46%. If complications, usually uncontrolled hypertension, renal deterioration or rejection, occur before 28 weeks of gestation then successful obstetric outcome occurs in 73% compared to 92% when pregnancy is trouble-free before 28 weeks. Remote problems occur in 11% of women after delivery but where the pregnancy is complicated prior to 28 weeks remote problems occur in 24%. It is of course, difficult to know whether problems are precipitated by pregnancy or are time-dependent and would have occurred in any case.