The optimal timing of pregnancy after kidney transplantation remains uncertain. In this analysis of 23,981 female first-kidney only transplant recipients of child-bearing age (15-45 years), primarily insured by Medicare between 1990 and 2008 captured in the USRDS, we identified 624 women who became pregnant during the first three post transplant years using Medicare claims (n = 189 in the first year , 224 in the second year, and 216 in the third post-transplant year).

In a Cox multivariate regression analysis adjusted for differences in age, race, cause of ESRD, donor source, duration of pre-transplant dialysis exposure, HLA match, PRA, transplant year, and maintenance immunosuppression, women who became pregnant in the first year (HR =1.21, 95% confidence interval (CI), 1.00, 1.46), and women who became pregnant in the second year (HR = 1.21, 95% CI, 1.01, 1.45), but not women who became pregnant in the third year (HR = 0.96, 95% CI 0.79, 1.18) had an increased risk of death censored graft loss compared to women who never became pregnant during these time intervals.

In a secondary multivariate Cox regression analysis restricted to the 576 women who became pregnant during the first three post transplant years and who had a functioning allograft three years after transplantation, women who became pregnant in the first post transplant year (HR =1.36, 95% CI, 1.01, 1.84), but not the second post transplant year (HR 1.26, 95% CI 0.94, 1.68) had an increased risk of death censored graft loss compared to women who became pregnant in the third post-transplant year.

The findings from this population-based analysis of Medicare insured women demonstrate that pregnancy in the first two post transplant years is associated with an increased risk of allograft failure. These findings may have implications for counseling patients regarding the timing of pregnancy after transplantation.

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