Single-Centre Review of Fertility, Reproductive Health, and Screening Program Use Among Women with Kidney Transplants

Background: Women with renal transplants have specific gynaecological and fertility needs beyond routine nephrology care. A substantial number are of reproductive age and their pregnancies are high-risk, with increased complication and rejection rates. Mycophenolate's teratogenicity highlights the importance of fertility and contraception counselling. Coordinating screening programs is complex, and transplant recipients' elevated malignancy risk necessitates annual cervical screening. HPV vaccination is crucial for preventing cervical and head/neck cancers in this population. Methods: We retrospectively reviewed electronic healthcare records of current female renal transplant recipients, collecting data on immunosuppression and medications, including contraceptives. We surveyed female renal transplant patients during clinic visits regarding reproductive health, contraception and participation in public health programs. Results: 81/210 transplant recipients were female. 54/81 (67%) completed the survey. 36 /81 (44%) of female transplant recipients were of child-bearing age. Of that cohort, 28 (78%) were on Mycophenolate based immunosuppression. 13 (36%) were prescribed contraception. 9 (26%) had unknown status. 8 patients (22%) were prescribed Mycophenolate but not contraception, one of whom was post-menopause. Of those using contraception, 54% used hormonal intrauterine devices. 5 patients had successful pregnancies post transplantation. No patients used IVF. 3 patients were planning or considering future pregnancy. 29/51 respondents (57%) had reached menopause. 5 (17%) had used HRT at any stage. 36 patients (67%) were enrolled in cervical cancer screening. 20 (37%) had a cervical smear within recommended interval. By comparison, 22 (41%) were enrolled in breast cancer screening. 5 (9%) had HPV vaccination. 33 (61%) had not and 14 (26%) did not know. Conclusion: Adherence with international guidelines regarding contraception in solid organ transplants in our cohort was suboptimal. Low uptake of cancer screening and limited use of HRT requires proactive management for optimal outcomes. Women with renal transplants have distinct reproductive health and fertility needs. A fully integrated electronic healthcare record including public health screening and immunisation records, currently unavailable in Ireland, would greatly benefit these patients.