Pregnancy after renal transplant: Truth or dare? A retrospective analysis from a tertiary care centre in India

Women with end-stage kidney disease (ESKD) often face fertility challenges due to hypothalamic-pituitary-gonadal axis disruption. While pregnancy is rare during dialysis, kidney transplantation restores fertility potential, albeit with increased maternal and foetal risks. This study evaluates maternal and foetal outcomes in post-renal transplant pregnancies at a tertiary care centre.

A retrospective study was conducted at our hospital on female renal transplant recipients between January 2010 and January 2024. All patients who conceived post-transplant were included. Clinical data were extracted from hospital electronic medical records, including transplant details, immunosuppression, antenatal course, and pregnancy outcomes.

Out of 215 female transplant recipients, 11 conceived post-transplant (5.1%). Among them, 9 pregnancies resulted in live births, 1 in stillbirth, and 1 ended in abortion. Mean age at pregnancy was 28.6 ± 1.74 years. All patients underwent ABO-compatible transplantation. Induction therapy included ATG (54.5%), basiliximab (27.3%), or none (18.2%). All patients were maintained on triple immunosuppression with tacrolimus, prednisone (≤10 mg/day), and azathioprine. Complications included maternal viz. gestational hypertension, pre-eclampsia, preterm delivery, and fetal viz. stillbirth and fetal growth restriction (FGR). Fetal outcomes included 81.8% live births, 9.1% intrauterine death, and 9.1% abortion. Graft outcomes showed stable function in 45.5%, dysfunction in 54.5%, and graft loss in 36.3%.

Pregnancy after kidney transplantation is feasible and frequently successful, though associated with maternal and foetal complications. Meticulous multidisciplinary care and regular monitoring are essential to optimize outcomes and preserve graft function.