The number of pregnant women with kidney transplant is growing and will continue to increase in Ukraine and all over the world, taking into account the development of transplantology. Such patients belong to the high-risk group, however, a clear understanding and adequate evaluation of the prognostic factors which are described in the literature will allow to transfer from prohibition and intimidation to the stage of supporting motherhood and providing highly qualified medical care to women with kidney transplants.This article presents two clinical cases of pregnancy and childbirth in women with kidney transplants, which occurred in the Department of Internal Pathology of Pregnant Women of the State Institution “Institute of Pediatrics, Obstetrics and Gynecology named after Acad. O. M. Lukyanova National Academy of Sciences of Ukraine”. Both patients with kidney transplants that functioned for 4 and 5 years, respectively, visited the doctor in early pregnancy.The anamnesis of the first pregnant woman was without peculiarities, while the second patient already had an episode of acute transplant rejection in the anamnesis and organ retransplantation from her mother. In addition, she had viral hepatitis B and C, as well as an insufficient level of immunosuppression. The function of the transplants in both women was satisfactory, each of the persons suffered from secondary nephrogenic anemia. Correction of immunosuppression in both patients was difficult, especially at 28 weeks, which is associated with hemodilution of pregnant women. Both women experienced an episode of urinary tract infection, which is experienced by about 40 % of pregnant kidney recipients.The first pregnant woman was practically healthy at full term pregnancy and had no indications for abdominal operation delivery, however, due to a clinically narrow pelvis she had cesarean section, which is a technically difficult surgery in such cases. In the second patient, the last weeks of pregnancy were complicated by hypertension of non-placental origin and transplant function disorders, which became an indication for cesarean section at 38 weeks. In the postpartum period kidney function began to recover. The condition of both newborns was satisfactory.Therefore, despite the reliable pregnancy outcomes in kidney transplant patients, an increased risk of obstetric complications and adverse perinatal outcomes remains. Interdisciplinary monitoring with timely correction of kidney transplant function disorders, monitoring of immunosuppressive therapy, prevention of premature births, careful control of blood pressure and adequate fetal monitoring allows to hope for favorable obstetric and perinatal outcomes in this group of patients.

The article is devoted to a review of the literature, which highlights the issues of maternal and perinatal complications and management of pregnant women who are renal transplant recipients.The risks of the development of hypertensive complications, preeclampsia, infectious complications, gestational diabetes and the risk of the fetus during pregnancy in these women are discussed in details. Pregnancy does not cause graft rejection, but pregestational hypertension, increased plasma creatinine and significant pregestational proteinuria are the risk factors for this complication. Pregnant women with a kidney transplant have a significantly higher risk of fetal growth retardation and premature birth.The article provides recommendations for the optimal period for pregnancy after transplantation which are recommended by various professional medical societies, although there is still no agreement on this issue: the American Society of Transplantation claims that the ideal period is 12-24 months after transplantation, while European best practice guidelines recommends to plan pregnancy no earlier than 2 years after surgery.The observation of pregnant women who are renal transplant recipients should be performed by an obstetrician-gynecologist with experience in high-risk pregnancy together with a transplantologist and perinatologist or neonatologist. All pregnant women who are kidney transplant recipients should be monitored for blood pressure, and aggressive antihypertensive therapy should be prescribed if it increases. It is also necessary to monitor the function of the graft, on suspicion of rejection it is possible to perform ultrasound-controlled kidney biopsy.The principles of immunosuppressive therapy during pregnancy, which includes prednisolone, methylprednisolone, tacrolimus, cyclosporine and azathioprine, and the description the side effects for the mother, the impact on the fetus and breastfeeding of each of the drugs are presented in the article. In the absence of obstetric complications, the optimal method of delivery is spontaneous delivery through the natural birth canal in the term of 38-40 weeks of pregnancy. Breastfeeding is recommended despite immunosuppressive therapy. Breast-feeding should be avoided when such medications as mycophenolate mofetil, sirolimus, everolimus and belatacept are used.Despite the high risk of pregnancy and childbirth, kidney transplant recipients have a good chance of pregnancy outcomes and giving birth to a living child while maintaining their own health. Therefore, motherhood should be encouraged among such women, supported and provided with highly qualified medical care.