To discuss the feasibility and safety of pregnancy and delivery after renal transplantation.

We retrospectively analyzed the clinical data of 9 women who underwent kidney transplantation in the First Affiliated Hospital of Wenzhou Medical University between 1997 and 2014. The average age of the 9 patients at the time of transplantation was (26±4) years old. Eight cases got cadaveric donor transplantation and 1 case got living related donor renal transplantation. The protopathy of recipients were all chronic glomerulonephritis and 2 among them were IgA nephropathy. There were 12 pregnancies in 9 recipients and 2 pregnancies failed. Average age of 9 recipients during pregnancy was (31±6) years old and the average interval between renal transplantation and pregnancy was (78±46) months.The indexes of graft function, immunosuppressant plasma concentration, complication of the mother and the fetus and growth development status of offspring at different time points (3 months before pregnancy, the first, second, third trimesters and 3 months after delivery) were observed.

The mean serum creatinine and estimated glomerular filtration rate (eGFR) of 9 recipients before pregnancy were (68±12) μmol/L and (94±18) mL·min^-1·(1.73 m²)^-1, the serum creatinine of 9 recipients during the first and second trimester were (66±13) and (62±13) μmol/L, the eGFR of 9 recipients during the first, second, third trimesters were (99±19), (114±24) and (112±26) mL·min^-1·(1.73 m²)^-1, there were statistical difference between all the above-mentioned data and the data of 3 months before pregnancy (P all <0.05). The mean lowest cyclosporine plasma concentration during the second trimester declined to (31±14) ng/mL from 3 months before pregnancy [(43±13) ng/mL ], which had statistical difference (P<0.05). No statistical difference was found in plasma concentration and dosage of tacrolimus. Two recipients developed preeclampsia and 6 recipients developed urinary infection. No acute rejection was observed. The median gestation of the 10 babies was (37.4±2.0) weeks (2 cases were preterm ); the median birthweight was 3 005 g with 1 case of low birth weight infant. The 1 min Apgar score of 1 newborn was 9.5 and the rest were all 10. The age of the offspring were 3 months to 17 years old up to July 2017, and no abnormality in intelligence, physical development and learning ability were observed, and there was also no immune system defect or attention deficit hyperactivity disorder.

Pregnancy after renal transplantation is risky for mother and fetus, but choosing the right time to be pregnant, taking appropriate immunosuppressive drugs, closely monitoring during perinatal period may improve the safety of pregnancy after renal transplantation