Life around the transplant
Pregnancy and fertility after a kidney transplant
Fertility often improves after a kidney transplant. Here is what public bodies say about planning ahead, reviewing medicines, timing and contraception with your transplant team.
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Many people with kidney failure wonder whether a family is still possible after a transplant. This page sets out what public bodies in the UK and the United States say about fertility, planning a pregnancy, the review of medicines, the timing guidance they give and contraception. It describes sources and does not replace advice. Practice differs between transplant centres, and the team looking after you has the final word on what applies to you. We do not quote outcome figures.
Fertility after a transplant
NHS Blood and Transplant says women of childbearing age are likely to find their fertility improves after a transplant, and that male fertility usually improves too. The National Kidney Foundation says the ability to have a child can return quickly for both men and women. Kidney Care UK says fertility can improve rapidly, which is why it stresses contraception in the first year.
The National Kidney Foundation also says that having a baby after a transplant is usually healthier and safer than while on dialysis. For men, it says fathering a child does not appear to cause problems for the recipient, the mother or the child, though some medicines used after a transplant can reduce a man's ability to father children.
Planning ahead with the transplant team
Every source puts the conversation with the team first. NHS Blood and Transplant says that for most patients pregnancy is possible, but it needs to be planned properly with the transplant team, because medicines may need to change and the body needs time to heal. Women planning a family must speak to the team before they start trying, it says, and men should also speak to theirs.
Kidney Care UK describes what that looks like: your kidney doctor will probably refer you to pre-pregnancy counselling with a kidney specialist and an obstetrician (a doctor who specialises in pregnancy and birth), to discuss what might happen, the best treatments and the monitoring you would need. The National Kidney Foundation describes a similar team, including an obstetrician who specialises in high-risk pregnancies, also called a maternal fetal medicine specialist.
The National Kidney Foundation is honest that pregnancy is not recommended for everyone: in some cases there is a high risk to the mother or baby, or a risk of losing the transplant. Kidney Care UK says very few women these days are advised not to get pregnant and that the decision rests with the woman and her partner, after learning about the possible problems in advance.
Timing guidance as the sources state it
The three sources agree on the main point. NHS Blood and Transplant says the team will usually suggest waiting one year before trying for a baby, to give time to adjust medications and make sure the transplant is working as it should. The National Kidney Foundation says it is usually recommended to wait at least one year, and that it is possible to become pregnant sooner but the risks of pregnancy-related problems may be greater. Kidney Care UK recommends delaying until at least one year after the transplant or after a rejection.
A year is a minimum. Kidney Care UK says you should ideally wait until kidney function is stable, blood pressure is well controlled and medicines have been changed to pregnancy-safe preparations, and that if your doctors change any medicine you should wait three months before trying, to make sure kidney function is stable. What counts as stable for you is a judgement for your team.
Reviewing medicines before trying
This part most often needs advance planning. NHS Blood and Transplant says some immunosuppressants can damage a baby as it develops in the womb, which is why women must talk to the team before trying. On its medicines page, it says women who wish to get pregnant while taking mycophenolate should discuss with their team whether they need an alternative. For men, it says medicines are less likely to need changing.
The National Kidney Foundation says all forms of mycophenolate increase the risk of pregnancy loss and birth defects, and that where possible they should be avoided in the six weeks before becoming pregnant and throughout pregnancy. It adds that for newer medicines such as sirolimus, everolimus and belatacept there is not as much information about whether or how they affect pregnancy. Kidney Care UK says mycophenolate drugs are not advised for women trying for a pregnancy because of the risk of malformation, and that the team will make the adjustments before conception.
One line from Kidney Care UK is worth repeating: "Do not stop your medication without taking medical advice." The wider picture is in immunosuppressant medicines after a transplant.
Contraception
All three sources say to discuss contraception with the team. NHS Blood and Transplant says to use contraception during the first year and that the team will discuss safe methods, and it directs readers to the team for hormone replacement therapy (HRT) advice too. Kidney Care UK says there are many types, to discuss them with your GP, kidney doctor or transplant team, and notes that condoms, the progesterone-only pill, a progesterone implant and the progesterone intrauterine system (the Mirena coil) are all safe and effective for women with kidney disease and transplants.
The National Kidney Foundation says sexually active people who have not gone through menopause should talk to their medical team about birth control, and that the right type depends on health history and personal wishes. It notes that many women with high blood pressure should not use the combined oral contraceptive pill, because it can raise blood pressure and the chance of blood clots. Your team can match a method to your blood pressure, medicines and wishes.
If you become pregnant
NHS Blood and Transplant asks that you let your transplant team know as soon as possible. Kidney Care UK says to contact your GP, who will refer you to maternity services, and to tell your kidney doctor or transplant team as well.
The sources describe closer care than usual. Kidney Care UK says women with a kidney transplant are more likely to have complications, depending on kidney function, blood pressure, protein in the urine and other factors. It names pre-eclampsia, a serious condition usually in the second half of pregnancy that causes high blood pressure and protein in the urine, and says the antenatal clinic will check for it. The National Kidney Foundation says appointments and blood draws become more frequent as the due date nears, and that anti-rejection doses will need to change as the baby grows.
Babies can be affected too. Kidney Care UK says a baby's growth may be affected and that babies are more likely to be born before 37 weeks, which is called premature. The National Kidney Foundation also reports that children of kidney transplant recipients are "overwhelmingly reported to be healthy and developing well in the long term". NHS Blood and Transplant says doctors may suggest giving birth in a hospital close to the transplant team, and Kidney Care UK says home births are not recommended, though most women with a transplant can expect a normal delivery. If a pregnancy brings worry, mental wellbeing and fatigue after transplant may help.
Breastfeeding
NHS Blood and Transplant says breastfeeding depends on the medicines you take and tells readers to speak to the team. Kidney Care UK says it is usually safe but some medicines pass into breast milk, so check with your doctor. The National Kidney Foundation says breastfeeding is an option and names tacrolimus, prednisone, azathioprine and cyclosporine as medicines generally safe for babies, while recommending a conversation with the team either way. Follow-up during and after pregnancy is covered in clinic follow-up and what the tests mean.
Frequently asked questions
How long should I wait after a transplant before trying for a baby?
NHS Blood and Transplant says the team will usually suggest waiting one year, and the National Kidney Foundation says it is usually recommended to wait at least one year. Kidney Care UK adds that kidney function should ideally be stable and blood pressure well controlled first. Your team decides what is right for you.
Will my fertility change after a kidney transplant?
The sources say it is likely to improve. NHS Blood and Transplant says it improves for women of childbearing age and usually for men too, and Kidney Care UK says it can improve rapidly, which is why it recommends contraception in the first year.
Do my medicines have to change before I get pregnant?
Possibly. NHS Blood and Transplant says some immunosuppressants can damage a developing baby and may need to change, and Kidney Care UK says some blood pressure and post-transplant medicines must be stopped before pregnancy. It also warns not to stop any medicine without medical advice.
Can men who have had a transplant become fathers?
Yes, according to NHS Blood and Transplant, which says fertility is likely to increase and that medicines are unlikely to need changing, though men should still speak to their team when planning a family. The National Kidney Foundation says fathering a child does not appear to cause problems for the recipient, the mother or the child.
The short version
Fertility often improves after a kidney transplant, so contraception and early conversations with the team matter from the first year. The sources agree on waiting at least a year, having stable kidney function and a medicines review before trying, and involving both the transplant team and an obstetrician. Everything beyond that is individual, which is what your transplant team is there to help with.