The purpose of this study was to examine the pregnancy outcomes among female kidney recipients who conceived before age 20. Data were collected by the National Transplantation Pregnancy Registry (NTPR) via questionnaires, telephone interviews, and medical records. Of the 977 female recipients in the NTPR there were 41 reporting 49 pregnancies and 50 outcomes conceived before age of 20. Conceptions occurred in the following eras: 1970s (4), 1980s (17), 1990s (22) and 2000s (6). The mean age at transplant was 15±2.6 yrs (range 6.3-18.8 yrs). The mean transplant to conception interval (TCI) was 3.1±2.2 yrs (range 0.1-10.4 yrs) with TCI<2 yrs in 21 pregnancies. Outcomes of the 49 pregnancies included 34 (69%) live births, 9 miscarriages, 5 terminations, and 2 stillbirths. Only 9 (28%) pregnancies were reported as being planned. Comorbid conditions during pregnancy included: treated hypertension 20 (47%), preeclampsia 6 (21%), infection 9 (22%), and rejection 2 (5%). Three (8%) recipients had biopsy-proven acute rejection within 3 months postpartum, all of whom conceived <2 yrs post-transplant. Additionally, 2 of the 4 recipients who lost their transplant within 2 yrs of deliveries conceived <2 yrs post-transplant. Mean serum creatinine before, during and after pregnancy was 1.3±0.5, 1.3±0.5, and 1.5±0.7 mg/dL, respectively. Of the 34 live births the mean gestational age was 37±2.6 wks; 38% were premature (<37 wks). The mean birthweight was 2624±547 g; 41% were low birthweight (<2500 g). There were no birth defects reported in the 34 live born. At a mean age of 15.6 yrs old, the offspring were reported healthy and developing well. At maternal follow-up (mean 18.3 yrs), 26 reported adequate transplant function, 2 reported poor/not functioning transplant and 11 recipients had died (mean 18.8 yrs after delivery; mean 21.9 yrs after transplant).

Conclusions: Kidney transplant recipients with a teen pregnancy have reported successful child and transplant outcomes. As found in overall kidney recipient cohorts, teen recipients who conceive <2 yrs post-transplant have increased risk of graft rejection and loss. All recipients with childbearing potential, but especially adolescents, must receive appropriate counseling regarding fertility after transplant, contraception, and the risks of conceiving too soon after transplant.

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