Is it safe to get pregnant after having a kidney transplant? This is a question many transplant patients ask. Fortunately, it is possible to have a healthy pregnancy with careful planning. 

In the National Kidney Foundation’s Kidney Commute Podcast, Dr. Silvi Shah, a transplant nephrologist at the University of Cincinnati, Amanda Trinsey, a kidney transplant recipient, and other clinicians specializing in kidney care discuss what you should know about getting pregnant after a transplant.* 

https://kidneycommute.podbean.com/e/reproductive-health-after-transplant/

What to expect after a kidney transplant?

Women with chronic kidney disease (CKD) or who are on dialysis often experience fertility impairment from hormonal changes. A kidney transplant will typically allow fertility to return within six to eight weeks in most women. 

“They will start having normal menstrual cycles, and the hormonal disruptions that occurred with chronic kidney disease revert back,” Shah says. “Normal levels of estrogen and progesterone and their sexual drive will likely return.”

How long should I wait to get pregnant?

Waiting to get pregnant for at least one year can decrease the risk of losing the transplant and unhealthy birth outcomes. 

Trinsey admits that after her transplant, she had regular menstrual cycles, but she waited two years before conceiving. “The goal was to have a planned pregnancy with all our ducks in a row, including my labs and medications,” she explains. “I was able to deliver two healthy babies almost to full term after receiving a kidney transplant.”

What are potential adverse outcomes? 

For transplant recipients, it is important to closely monitor your kidney function and discuss your desire to get pregnant with your healthcare team. During pregnancy, transplant recipients can still be at risk of: 

• Pre-eclampsia
• High blood pressure
• Transplant rejection 

To avoid these outcomes, you should strive to have: 

• A stable estimated glomerular filtration rate (eGFR) or kidney function
• No proteinuria (protein in the urine)
• Well-controlled blood pressure
• Well-controlled blood sugar
• No recent rejection episodes

Understanding your state’s abortion laws is important, as terminating a pregnancy for kidney-threatening complications may not be an option. 

What are adverse birth outcomes?

Post-transplant medications, such as immunosuppression medications, could affect your baby and lead to these possible adverse outcomes: 

• Pregnancy loss if taking teratogenic medications
• Preterm births
• Low birth weight

Once you become pregnant, you and your doctor should monitor your creatinine levels closely. Levels over 1.5 mg/dL could put your baby at higher risk for adverse outcomes. 

Where can I learn more?

While working with your team is key to ensuring a safe pregnancy after transplant, the NKF also offers resources that address frequently asked questions and sexuality after a kidney transplant. 

*Kidney Commute CE Study Guide: Reproductive Health After Kidney. (2023, April 27). National Kidney Foundation. https://www.kidney.org/newsletter/kidney-commute-ce-study-guide-reproductive-health-after-kidney-transplant