Renal Transplantation and Pregnancy

Vincent T. Armenti, Michael J. Moritz, and John M. Davison

In March 1958, a healthy baby boy was delivered by cesarean section performed on a female renal transplant recipient. This was the first documented successful pregnancy in this group of patients, and it heralded the era of such offspring. There are approximately 10,000 renal transplants performed annually in the United States. Extrapolating, roughly 80-90% are successful, about 40% of recipients are female, and approximately 55% are between 20 and 44 years of age, creating over 1700 potentially fertile transplant recipients annually. Over 15,000 pregnancies after transplantation have since occurred as reported in the publication of single center experiences, case reports, registry data, and reviews. Since 1991 there has been a resource: the National Transplantation Pregnancy Registry (NTPR) at Thomas Jefferson University. Overall, most female renal transplant recipients with good graft function can expect a successful pregnancy outcome for mother, newborn and graft. Increased risk is associated with poorer renal function, proteinuria, and potentially a shorter interval between transplant and conception. Concerns for the obstetrician are the safety of pregnancy for mother and her transplant as well as the potential for adverse gestational and neonatal effects of comorbid conditions and multiple medications, including immunosuppressive medications.

Data from the NTPR are reviewed against the background of the accruing world literature, focusing on counseling of female renal transplant recipients who are considering parenthood and what they might expect in pregnancy and beyond. In reviewing the complex issues in this population, this chapter will underscore the necessity for well-orchestrated teamwork involving obstetrician, all transplant personnel, and neonatologist.