Patients with end-stage renal disease (ESRD) are often infertile or have low pregnancy rates due to hypothalamic dysfunction. These endocrine and menstrual dysfunctions are restored after kidney transplantation, which is one of the benefits of kidney transplantation for women of childbearing age. An important indicator of the rehabilitation of patients after transplantation is the restoration of reproductive function and the ability to give birth to healthy children. 
Purpose: To analyze possible prognostic factors of pregnancy outcomes in kidney transplant recipients.
Materials and methods: Women of childbearing age account for about 20%. For the purposes of the study, clinical data were taken from 12 women who gave birth between 2021 and 2024, and 3 kidney transplant recipients preparing for childbirth.
Results: The mean age of the patients was 28 years. Childbearing counseling began before kidney transplantation and was provided at every clinic visit after transplantation. The average interval between transplantation and pregnancy was 2-5 years. Live birth rate was 93,3% (fetal death n = 1). Complications such as arterial hypertension were observed in 2 patients (13.3%), anemia in 2 (13.3%), TORCH infections were detected in 3 (20%) pregnant women before conception, which were treated in a timely manner, and urinary tract infections pathways was observed in 4 (26.6%). Preeclampsia was diagnosed in 1 case (6.67%), renal dysfunction - in 1 (6.67%), which resolved one month after delivery. Only one recipient had anemia during pregnancy and postpartum. There were no other complications such as gestational diabetes mellitus, urinary tract infections, and congenital malformations of the fetus. Premature birth occurred in 3 (20%) recipient at 37-38 weeks of gestation. Four (26.6%) newborns were small for gestational age. Cesarean section was performed in 4 (26.6%) patients, the main indications are associated with arterial hypertension and edematous syndrome. The average gestational age at the time of delivery was about 38-39 weeks. The average body weight of the fetus at birth is 2.5 kg.
All pregnant women received standard immunosuppressive therapy. Calcineurin inhibitors (tacrolimus) were part of the main immunosuppressive therapy in all pregnant women. Our pregnant women stopped using mycophenolate mofetil 3 weeks before conception. Mycophenolate mofetil has been replaced to azathioprine. To assess changes in kidney function throughout gestation, we monitored the levels of all relevant renal data throughout pregnancy and postpartum.
Conclusion: All pregnancies were successful and led to the birth of a child. Based on our data, pregnancy did not adversely affect graft function.  Good results were directly related to stable kidney function and the absence of infections during pregnancy and postpartum, well-controlled hypertension and proteinuria, minimal doses of immunosuppressants, and time from transplantation to pregnancy.