Background: The fertility of women of childbearing age temporary improves within 2 to 3 weeks of successful renal transplantation and after 6 months, circulatory sex hormones are restored, however, pregnancy after kidney transplantation is challenging and may be associated with serious maternal and fetal complications. Objective: To study the prevalence of pregnancy and pregnancy related complication after kidney transplantation (KT). Patients and Method: Retrospective cohort study conducted on 236 patients out of 3000 kidney transplant recipient who underwent renal transplantation (RT) at Mansoura Urology and Nephrology Centre between March 1976 and December 2019, divided into two groups, group I; 118 kidney transplant female’s recipient experienced pregnancy at any time after kidney transplant and Group II; 118 kidney transplant female’s recipients who didn`t experience pregnancy after renal transplantation, they were matched according to age, duration of renal transplantation and they are comparable in primary immunosuppressant drugs. all kidney recipients were reviewed for preoperative & operative and post-operative details also we record maternal and fetal complication. Results: prevalence of pregnancy in our centre is 191 pregnancies in 118 women who had undergone kidney transplantation between 1976 and 2019. We have found that the mean age of pregnancy between (26.27±4.37 - 29.89±4.6), the mean gestational age between (33.69±6.4 - 33±7.5) weeks, the live birth rate is 126 (66%). Preterm delivery rate in our study is 85 (44.5%), neonatal death 8 (4.1%), miscarriage 59 (30.9%), intrauterine fetal death 6 (3.1%) and birth defect 4 (2%). The prevalence rates of gestational hypertension is 87 (45.5%), pre-eclampsia 48 (25.1%), gestational diabetes 19 (9.9%), urinary tract infection 36 (18.8%), and graft rejection 8 (4.1%) during pregnancy. caesarean section is the most common method of delivery in our study 133 (69.6%). Conclusions: Even increase rate of live births outcome, but the risks of maternal and fetal complications are still high in renal transplantation patients and requires multidisciplinary care. All should be considered in patient counseling and clinical decision making. So, we recommend educating the transplanted patients to allow for outcome optimization and minimization of complications.