The article is devoted to the problem of the effect of pregnancy on alloimmunization in women with stage 5 chronic kidney disease and the choice of a donor and immunosuppression for kidney allotransplantation. The analysis showed that alloimmunization of pregnant women is common and remains poorly studied. Studies suggest that endogenous mechanisms contributing to maternal-fetal tolerance during pregnancy may persist in the postpartum period. Moreover, it remains to be determined whether this immunological balance can be used to improve transplant outcomes. Thus, significant opportunities remain for clinical researchers to contribute to this field and improve transplant outcomes for sensitized women.