Pregnancy in the renal transplant recipient

March 10th, 1958, is the birthday of the first baby born to a kidney transplant recipient. The pregnancy went to term and the baby was delivered by cesarean section for fear that a vaginal birth could adversely affect the allograft kidney sitting in the iliac fossa. Undoubtedly, this pregnancy more than 50 years ago was considered high risk because of its pioneering nature. However, given that the transplant recipient had received her kidney from her identical twin sister approximately 2 years before and was not taking any immunosuppressive medications, the pregnancy was associated with far fewer risks than most pregnancies in transplant recipients of today. Not only are immunosuppressants now available that have potential adverse affects on the developing fetus but also many kidney transplant recipients have kidney function that is suboptimal. Although thousands of women with kidney transplants have successfully delivered healthy babies, many new issues must be considered during a transplant recipient's pregnancy compared with 50 years ago. These issues are discussed in this article.