Evaluation of Pregnancy in Kidney Transplant Recipient: A Nationwide Retrospective Study

Background Kidney transplantation significantly enhances the quality of life and restores fertility for women of childbearing age. Although pregnancy risks in allograft recipients are documented globally, there is a distinct lack of evaluated data regarding outcomes within the Middle Eastern population. This study aimed to evaluate maternal, fetal, and graft outcomes, alongside associated risks, among kidney transplant recipients in state of Qatar. Methods We performed a nationwide retrospective observational study at a nationwide kidney transplantation center. The cohort included 91 female recipients of reproductive age (15–49 years) who underwent transplantation between January 2016 and December 2023. Clinical data, including demographics, immunosuppression protocols, and laboratory parameters, were extracted from national electronic medical records. Results Within the cohort of 91 females, 12 recipients (13.2%) had a total of 14 pregnancy events, with a mean age of 36 ± 3.7 years at the time of conception. The live birth rate was 57% (8/14), while adverse outcomes included early pregnancy loss (21%), spontaneous abortions between 12 to 20 weeks (14%), and one case of preeclampsia-related intrauterine fetal demise (7%). Notably, 75% of patients (3 out of 4) with a pre-conception serum creatinine > 120 µmol/L experienced adverse outcomes. While allograft function remained stable in the majority of successful deliveries, two patients experienced persistent graft dysfunction postpartum, with one requiring a return to dialysis due to chronic allograft nephropathy. All patients were successfully transitioned from mycophenolate mofetil to azathioprine for pregnancy. Conclusion Pregnancy post-kidney transplantation in Qatar is associated with acceptable outcomes for the mother, fetus, and allograft when managed with rigorous multi-specialty involvement. However, pre-conception graft function, specifically a serum creatinine level < 120 µmol/L, remains a critical predictor of pregnancy success. These findings emphasize the need for individualized counseling and vigilant monitoring to mitigate risks of rejection and graft loss