Study finds pregnancy risks higher with ART in kidney transplant recipients

Study finds pregnancy risks higher with ART in kidney transplant recipients | Image Credit: © SewcreamStudio - © SewcreamStudio - stock.adobe.com.

The odds of complications during pregnancy may be increased among women with kidney transplants conceiving through assisted reproductive technology (ART), according to a recent study published in Transplantation.¹

Limited existing data on ART in kidney transplant patients

This data is among the first large-scale research assessing pregnancy outcomes in women with kidney transplants. Alongside increased hypertension risk, this population presented with increased risks of cesarean delivery, preterm birth, and reduced infant birth weight.¹

“Until now, little has been known about the outcomes of pregnancies using assisted reproductive technology in women with kidney transplants,” said Silvi Shah, MD, associate professor at the University of Cincinnati College of Medicine. “Our study provides valuable evidence to guide physicians when counseling patients toward family-planning decision-making and the use of assisted reproductive technology."¹

Fertility challenges in women with kidney disease

Women with chronic kidney disease often experience significant adverse impacts on fertility. A large proportion of this population may be able to conceive naturally following kidney transplantation, but some may continue to experience infertility, requiring the use of ART to conceive.¹

The retrospective cohort study was conducted to address the gap in knowledge about pregnancy outcomes linked to ART in women with kidney transplants.² Data was obtained from the Transplant Pregnancy Registry International.

Participants included female patients aged at least 14 years old at conception who received a kidney transplant between March 1988 and July 2022. Pregnancy outcomes were compared among those receiving ART vs undergoing natural conception through logistic regression analyses. Adjustments were made for race and age at conception.²

Higher risks of pregnancy complications

ART use was reported in 130 pregnancies across 77 women who underwent kidney transplant. The odds of hypertension were reported among these pregnancies vs those without ART use, with an odds ratio (OR) of 1.57.²

ORs for cesarean delivery and preterm birth under 37 weeks were 1.60 and 2.07, respectively, highlighting a significant increase in risk among kidney transplant recipients with ART use. These patients also had a reduced median infant birth weight, at 2551 g vs 2722 g among those with natural conception.²

Preeclampsia, gestational diabetes, miscarriage, live birth, low birth weight, birth defects, and 2-year graft loss rates did not significantly differ between kidney transplant recipients with ART use vs natural conception. However, neonatal deaths were higher in the former group vs the latter group, at 4.4% vs 0.8%, respectively.²

Clinical implications

These results highlighted increased risks of certain pregnancy complications among kidney transplant recipients utilizing ART. However, as other risks such as live birth rates and 2-year kidney transplant survival did not increase, investigators concluded ART remains safe for use in patients who received a kidney transplant.¹

Shah noted that this data allows for a greater understanding of how clinicians can optimize care for kidney transplant recipients planning to conceive with ART. Additionally, clinicians may use this information to help patients make informed reproductive choices.¹

“It’s safe for women with kidney transplants to pursue ART, provided they have stable creatinine value, optimal immunosuppression, well-controlled blood pressure, and no recent episodes of rejection,” said Shah. “We now have data showing that while certain risks are higher, outcomes such as long-term kidney function and live birth rates are not negatively impacted.¹

References

1. University of Cincinnati study explores fertility treatment risks for kidney transplant recipients. University of Cincinnati. July 7, 2025. Accessed July 11, 2025. https://www.eurekalert.org/news-releases/1090242.
2. Shah S, Rachwal B, Vyas P, et al. Pregnancy outcomes using assisted reproductive technology in kidney transplant recipients. Transplantation. 2025. doi:10.1097/TP.0000000000005449