Management and Outcomes of Pregnancy After Kidney Transplant: A Single-Center Retrospective Study from Azerbaijan

Kidney transplant restores fertility in female recipients with end-stage renal disease; however, pregnancy in this population is classified as a high-risk condition. Data regarding pregnancy outcomes in kidney transplant recipients within the Azerbaijani population remain limited.

A retrospective analysis was conducted on female living donor kidney transplant recipients at the State Security Service Military Hospital in Baku, Azerbaijan, from 2017 to 2024. The study evaluated demographics, immunosuppression adjust-ments, renal function, and obstetric compli-cations.

Among 208 transplant cases, 13 pregnancies were identified in 10 recipients. The median age at conception was 28.3 years, with a median post-transplant interval of 32.7 months. All patients discontinued mycophenolate mofetil at 6 weeks prior to conception. Renal function remained stable, with no significant differences in serum creatinine levels between pre-pregnancy (1.05 mg/dL) and 3 months postpartum (1.07 mg/dL), and no acute rejection episodes occurred. Maternal complications included gestational hypertension (30.8%), urinary tract infections (23.1%), and physiological hydronephrosis (23.1%). The live birth rate was 92.3% (12 of 13 births). All deliveries were via cesarean section; 38.5% were premature (<37 weeks). Neonatal outcomes were positive, with no major congenital anomalies.

Pregnancy after kidney transplant is feasible and safe for both mother and graft under a strict multidisciplinary follow-up regimen. Despite risks of prematurity and hypertension, vigilant monitoring ensures high live birth rates without compromising graft stability.