Resumption of Female Reproductive Function Following Renal Transplantation

Menstrual patterns and fertility were studied in 27 renal transplant survivors aged 13 to 39 years. Amenorrhea was present before transplant in 26 women. Recovery of regular menses correlated with the level of renal function and the frequency and severity of rejection episodes. Five pregnancies occurred in four patients. All of these patients were delivered successfully of healthy babies in the face of unaltered immunosuppressive therapy. Vaginal delivery was feasible in three instances, but obstruction of the fetal head by the graft necessitated cesarean section in two women. Renal function declined in the third trimester in most cases, but returned promptly to normal after delivery. Determination of urinary estriol levels and combined intravenous pyelography and x-ray pelvimetry aided in the management of the pregnancies. Graft-directed antibodies were not induced by the fetuses in the cases studied.