*Purpose: The chance of successful pregnancy is low in women with end stage renal disease. In women with type-1 DM, not only are the fertility rates lower, but the proportion of new-borns with congenital malformation are higher than the general population. SPK transplantation improves fertility rates and the chance of a successful pregnancy. Aim of this study is to document pregnancy and allograft outcomes in this cohort.

*Methods: All women who underwent SPK transplantation between 01.01.1998 – 01.08.2019 at our centre and then had a subsequent pregnancy are included. Patient records, obstetric records and neonatal discharge summaries were accessed. Maternal complications during pregnancy, fetal, neonatal and graft outcomes were observed.

*Results: 13 women were identified to have had 17 pregnancies, 10 women had one pregnancy and three had more than one. Median age at delivery and the median time lag from transplantation to first pregnancy were 35.5 years and 5 years, respectively. There were 11 successful pregnancies. Of the 6 unsuccessful pregnancies, 4 pregnancies were lost due to miscarriage. 83% of the unsuccessful pregnancies were unplanned. One patient lost both pancreas and kidney grafts in pregnancy. Two patients lost their kidney grafts at least 1 year after pregnancy. There were two episodes of transplant ureteric obstruction secondary to extrinsic compression by the gravid uterus, which were managed by nephrostomy and ante-grade stent insertion. Rates of pre-eclampsia and pre-term delivery were 77% and 69%, respectively. Median gestation age at birth was 34 weeks. C-section rate was 75%. There were no congenital anomalies or neonatal deaths.

*Conclusions: This is a high risk group for grafts and children. Pre-pregnancy planning is vital. Multi-disciplinary approach by obstetric and transplant teams is important pre-pregnancy, antenatally and peripartum.

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