This is a retrospective case-note review study investigating the outcome of 234 pregnancies in 140 renal transplant recipients from five different Middle Eastern countries. 74.4% of the pregnancies were successful albeit with high prevalence of pre-term and Caesarean section deliveries (40.8% and 53 % % respectively.) The mean serum creatinine did not significantly rise during pregnancy in the group as a whole but did so in patients who had serum creatinine of 150umol/L or higher at the beginning of their pregnancies .The mean birth weight was (2458 gms) with 41.3% of the newborns being of low birth weight (<2500 gms). The prevalence of stillbirths were 7.3% and of spontaneous abortion was 19.3 %. Pre-eclampsia and gestational diabetes were observed in 26.1% and 2% of pregnancies respectively. In conclusion, The presence of good allograft function the majority of pregnancies in renal transplant recipients have a good outcome but with increased incidence of pre-eclampsia, reduced gestational age and low birth weights. Patients with baseline serum creatinine of above 150 umol/L have an increased risk of allograft dysfunction resulting from pregnancy.