Introduction Fertility rapidly returns to women after successful kidney transplantation. The aim of this study was to collect information about pregnancy, delivery and renal outcomes among all kidney transplant recipients in our centre.

Methods Pregnant women with a kidney transplant were identified through our prospectively maintained electronic patient record and case-notes between January 1, 1970 and February 28, 2013. We retrospectively analysed 40 years of pregnancy-related outcomes from 138 pregnancies reported from 89 kidney transplant recipients.

Results Mean ages at the time of transplantation and pregnancy were 25.2 years and 30.3 years, respectively. Outcomes included 102 (73.9%) live births, 23 (16.7%) miscarriages, 8 (5.8%) terminations, 2 (1.4%) stillbirths, and 3 (2.2%) ectopic pregnancies. There were live births in 73.9% of pregnancies, with a high prevalence of preterm and caesarean deliveries (59.8% and 88.5%, respectively). Preexisting hypertension was present in 56 patients (40.6%) and preeclampsia was observed in 8.7% of pregnancies. Seven patients (5.1%) had an episode of acute rejection during pregnancy (three of which resulted in transplant failure). Mean age at conception, time interval between transplantation and pregnancy, 10-year incidence of live and preterm births (per prevalent pregnancies in kidney transplant recipients) remained unchanged over the last four decades (1970–1980, 1980–1990, 1990–2000, and 2000–2010).

Conclusion The majority of pregnancies in renal transplant recipients have a good outcome but with increased risk of miscarriages, preterm and caesarean deliveries. Despite advances in immunosuppression, the incidence of live and preterm births has not changed over the last four decades in our unit.