Background: The Transplantation Pregnancy Registry International (TPRI) has been collecting pregnancy data for over 34 years in all solid organ transplant recipients.
Methods: Data are collected via questionnaires, interviews, online surveys, and review of medical records; retrospective and prospective pregnancy reports are accepted, and recipients worldwide can participate.
Results: The purpose of this study is to highlight the pregnancy outcomes in female  kidney transplant recipients and the long-term outcomes of their children. The kidney cohort is the largest in the TPRI and comprises 1,471 female recipients reporting 2,659 pregnancies with 2,754 pregnancy outcomes (includes multiple births). The mean age at transplant is 24 years and the mean transplant to conception interval is 5.7 years, with 70% reported as being planned. Most pregnancies (76%) are exposed to a calcineurin inhibitor (cyclosporine 35% and tacrolimus 41%).  Comorbid conditions during pregnancy include drug-treated hypertension 48%, insulin treated diabetes 6%, and preeclampsia 30%. Rejection during pregnancy was reported in 3% and graft loss within 2 years of delivery was 5.5%.  Pregnancy outcomes include ectopic 1%, stillbirth 2%, terminations 4%, miscarriages 19% and live births 74%. The mean gestational age of the 2,051 live births is 35.7 weeks and mean birthweight is 2543 g; 52% of the infants are born preterm (<37 weeks). Cesarean delivery occurred in 52% and 4.8% of infants had a birth defect. In a study of 1,813 live births with greater than 1 year of TPRI follow-up, the majority 1,372 (75.6%) of the children were reported as healthy and developing well at the last interview with their mother. Common diagnoses were allergies/asthma (6.2%), and renal disease (3.3%) most commonly due to anatomical malformation. There were also 169 (9.3%) children with a behavioral or psychiatric disorder reported in their child. At last maternal follow-up with a mean of 15.1 years, kidney function was reported as adequate in 64% of the recipients and there were 21% maternal deaths. 
Conclusions: It is possible for female kidney transplant recipients to have successful pregnancies. Most of the pregnancies result in live births with good long-term health of their children. Incidences of hypertension and preeclampsia remain high compared to the general population contributing to the higher rates of prematurity and low-birthweight. It is important to have a planned pregnancy to optimize kidney function and avoid medications that are harmful to the fetus. The TPRI is a resource for the worldwide transplant community.