*Purpose: Pregnancy after renal transplantation (tx) means a risk for mother, child, and the renal graft. We aimed to specify the main risks.

*Methods: We evaluated the course and complications of all pregnancies (lasting more than 3 months) after renal transplantation since 1973 in Hannover by reviewing the records for complications regarding outcome of the child, renal function, blood pressure and proteinuria of the mother, and graft survival.

*Results: We found 62 women with 85 pregnancies and 88 deliveries. 93.2% of pregnancies happened during the time of the first transplant of the women. Pediatrich tx was 15%,; living donation 25%. One woman had 4 Kids, 3 women 3 kids each, 16 wpmen 2 kids each, and 43 women 1 kid each Four women (6.5%) lost their graft by pregnancy; 2 by haemolytic-uremic syndrome (HUS) (1 with death of the child); 1 by severe preeclampsia; 1 by severe rejection (stopping immunosuppression shortly after birth). Complications during pregnancies were preeclampsia-related problems (29.6%), urinary obstruction (8%), rejection (5%) , intrahepatic cholestasis (6%), strangling by the umbilical cord (3%) and urinary tract infections (mostly not well documented). 68.2% of children were born by cesarian section. Seven children (8%) died before or shortly after birth (late interruption of a twin pregnancy because of medical reasons; severe retroperitoneal bleeding of the mother; placenta problem; preeclampsia; HUS of the mother: unknown reason). The age of the mothers at tx was 23.9±8.9 and at delivery 30.8±8.8 years; the time period from tx up to childbearing was 7.2±5.7 years (0.8 – 28.3 years). Renal function (eGFR CKD-epi-creat) before pregnancy was 59±23 mL/min; % loss of eGFR by pregnancy was 15±21% (0-86%, usually not by rejection). The children were born at gestation week 34±12; the birth weight of the children was 2502±3157g. The % loss of eGFR by pregnancy correlated with the time up to graft failure after delivery (n=28, R= -0.55, p=0.005); eGFR before pregnancy correlated with % loss of eGFR after pregnancy (n=76, R=-0.268, p=0.02), with the gestation week at delivery (n=76, R=0.457, p=0.0001), and with the time up to graft failure after delivery (n=29, R=0.371, p=0.04). Ten mothers (16.1%) died during the observation time 1-21 years after pregnancy (infection 3, heart failure 2, coronary heart disease 1, malignancy 2, intraperitoneal bleeding 1, accident 1).

*Conclusions: Women after renal tx have a risk to lose their graft during pregnancy and to die of various reasons before their children are adult. Renal function before pregnancy plays a key role for a good outcome of the mother and her graft as well as for the child.

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