Pregnancy After Kidney Transplantation.

Successful pregnancy after kidney transplantation has been reported worldwide since the 1960s and much of the clinical guidance regarding post-transplant pregnancy is derived from the experience in kidney recipients. This chapter includes a review of the relevant literature plus data from the National Transplantation Pregnancy Registry (NTPR) regarding pregnancy, maternal and newborn outcomes in this population and clinical management guidelines for the care of kidney transplant recipients before, during, and after pregnancy. Fertility is often restored soon after successful kidney transplantation; therefore, appropriate contraception and pregnancy counselling should be key components of pre- and post-transplant care. Conception planning is strongly recommended. If the recipient’s immunosuppressive regimen includes a mycophenolic acid (MPA) product, modifying the medication regimen prior to conception should be seriously considered as exposure confers substantial risks to the fetus. Close monitoring of the recipient, the transplant function, and her medications should continue throughout the pregnancy and postpartum. Post-transplant pregnancies are high-risk and warrant close collaboration among multiple disciplines to provide the best possible outcome for mother, her graft, and child