The literature contains reports of 2,309 pregnancies in some 1,600 women who have undergone renal transplantation. Certain pre-pregnancy factors, especially hypertension, renal graft dysfunction and short interval between transplant and pregnancy, appear to increase the neonatal risks. We describe the outcome of 42 pregnancies in 27 allograft recipients at Beilinson Medical Center in Israel during the last 8 years. All were treated with combination immunosuppression regimens. The average interval from time of transplantation to conception was 3.7 +/- 0.4 years (2 months to 9 years). Rejection episodes occurred in 37% prior to pregnancy but in none during or immediately after pregnancy. Of the 42 pregnancies 28% ended in therapeutic or spontaneous abortions, and 29 of the 30 deliveries ended in a life birth. The prematurity rate (65%) was similar to that described in the literature. Renal deterioration was evident in seven women (26%) within 2 years after delivery. Despite this significant success rate, pregnancy in organ transplant patients should still be considered high risk.