2021 marked 30 years of continuous data collection by the Transplant Pregnancy Registry International (TPRI). Since 1991, the TPRI has studied pregnancies in solid-organ transplant recipients. In 2016 the TPRI expanded to include international participants and pregnancies from 25 different countries are now included. Data are collected via telephone interviews, online questionnaires, and review of medical records.  The TPRI follows participants and their children indefinitely. To date, 1,836 female solid organ transplant recipients, including 1,251 kidney recipients, participate in the TPRI (Table).

There are also smaller numbers of multi-organ recipients, i.e. heart-lung, liver-kidney, uterus etc. Most children are reported healthy and developing well. About 250 grandchildren now comprise a second generation providing the ability to study theoretical concerns about potential far-reaching effects of in utero exposure to immunosuppressive medications. TPRI analyses have contributed to clinical recommendations regarding advisability and timing of pregnancy, immunosuppressive medications, comorbid conditions, and other aspects of post-transplant motherhood. The TPRI also serves as a resource for recipients who are making family planning decisions. Pregnancy considerations vary depending on the organ transplanted, but the most significant factors for successful outcomes for mother and child are stable prepregnancy transplant function, avoidance of mycophenolic acid during the 1st trimester, and close follow-up by a multi-disciplinary team during pregnancy and postpartum.

Conclusions: The TPRI is a reliable resource for the worldwide transplant community. For many recipients, pregnancy after organ transplantation is possible with the majority of the pregnancies resulting in a healthy live birth. Healthcare providers who counsel transplant recipients about parenthood and transplant recipients themselves are encouraged to contact the TPRI.