The purpose of this study is to describe 2102 pregnancies in 1164 kidney transplant recipients reporting to the Transplant Pregnancy Registry International (TPR) from 1991-2019. Data were collected via questionnaires, telephone interviews, and medical records review. Data are listed in the table below. 

The majority of recipients were on calcineurin inhibitor therapy for immunosuppression; 44% on cyclosporine and 33% on tacrolimus, while 24% on other regimens the majority being azathioprine/prednisone; 8% of pregnancies were exposed to a mycophenolic acid product (MPA) during the first trimester. There were a total of 2179 pregnancy outcomes (including multiples) resulting in 1631 live births (75%), miscarriages (18.5%), terminations (4%), stillbirths (2%) and ectopic pregnancies (1%). There were 170 1st trimester exposures to MPA resulting in 5 terminations, 3 stillbirths, 82 miscarriages, 80 live births (9 with birth defects). There was a two-fold increase in reporting of fertility issues (22%) compared to the general population (11%) and 28 recipients conceived via in vitro fertilization. Livebirth outcomes are listed in the table. There were 306 infants who were breastfed. The TPR has been following the offspring long-term: mean age of the children 14.3 ± 11 yrs. With a mean maternal follow-up of 15±11.5 yrs, 208 recipients have died, 52 reported reduced function, 103 were on dialysis, 28 were lost to follow-up, and 773 reported adequate transplant function.
Conclusions: Female kidney transplant recipients have reported successful pregnancies, with a live birth rate of 75%, and low incidence of rejection during pregnancy (3%). There is an increased risk of premature and low birth weight infants. The risk of miscarriage and birth defects when pregnancies are exposed to MPA in utero underscores the need for pre-conception counseling. Infertility in kidney transplant recipients requires additional study. The TPR will continue to follow these recipients and their children and report the outcomes to the transplant community.  All centers worldwide are encouraged to have their recipients report all pregnancies to the TPR.