Introduction: Fertility and sexual functions could rapidly restore after successful renal transplantation (RTx). This study was to examine the outcomes of pregnancy and graft survival between genders in our RTx recipients, and perinatal and fetal complications.

Methods: From May 1983 to December 2021, a total 1514 patients received RTx at our center, and 790 recipients within reproductive age (15-45 yrs, Female/Male: 344/446). There were 31 pregnancies recorded in 24 female recipients with 6 multigravida and one twin pregnancy, while 26 male recipients have their couples to get 35 pregnancies (including 8 multigravida).

Results: There was no difference between age of pregnancy, interval between RTx to delivery, immunosuppressive agents, and serum creatinine (sCr) before and after pregnancy. Female pregnancy recipients had more frequent in hypertension, urinary tract infection, anemia, and preeclampsia. The gestational age at delivery was 36.6 ± 3.6 weeks in female group significantly shorter than that of in male group (38.8 ± 0.7 weeks, P = 0.027). The birth weight/fetal length is 2470.7 ± 497.2 gm/45.9 ± 3.7 cm in female RTx recipients lower than 3172.7 ± 244.4 gm/48.8 ± 1.2 cm in male (P = 0.000). Unfortunately, the deterioration of graft function of sCr is from 1.8 ± 0.7 vs. 1.4 ± 0.4 mg/dL in year 2 to 2.0 ± 0.8 vs. 1.4 ± 0.4 mg/dL in year 3 between female vs. male RTx recipients. There are 10 graft failures in female group (66.7%), but none in male group during the follow-up period (P = 0.000).

Conclusion: In conclusion, our limited experience disclosed poor graft function and survival in our female recipient with pregnancy, and more low birth weight of fetus and preterm delivery. Female RTx recipients should be closely antenatal, perinatal and postpartum monitored to avoid complications in pregnancy.