Medical management of the pregnant transplant recipient.

Retrospective analyses of pregnancies in female renal transplant recipients including case reports, center reports, and questionnaire surveys have, for the most part, reached similar conclusions. In the presence of adequate, stable graft function, these high-risk pregnancies are generally well tolerated, but the majority of the liveborn outcomes are premature and many of the newborns are low birthweight. Obstetrical complications such as preeclampsia and cesarean section occur in a significant proportion of cases. With improvements in methods of data acquisition and computer technology, the aim for the future must be enhanced communication between transplant centers on a prospective basis, perhaps comparing cases with patient profiles derived from analyzed databases such as the National Transplantation Pregnancy Registry (NTPR). Continued efforts to identify prepregnancy risk factors as well as optimal antenatal management strategies will help to further improve pregnancy outcomes in this population. Discussed in this review are reports from the literature as well as current data from the NTPR focusing on the medical management of pregnancy in the renal transplant recipient.