**5. Pregnancy post transplant**

quite large. For example, the 95 percent confidence intervals for the under-five mortality esti‐ mate of 94 per 1,000 are 86 and 103 per 1,000 indicating that, given the sample size of the 2006-07 PDHS, the true value may fall anywhere between 86 and 103 per 1,000 births. As observed in most studies, the mother's level of education is strongly linked to child survival. Higher levels of educational attainment are generally associated with lower mortality rates because educa‐ tion exposes mothers to information about better nutrition, use of contraceptives to space births, and knowledge about childhood illness and treatment. Similarly, childhood mortality rates decline as the wealth quintile increases. Only 34 percent of births in Pakistan take place in a health facility. Eleven percent is delivered in a public sector health facility and 23 percent in a private facility. Three out of five births (65 percent) take place at home. (Pakistan Demo‐ graphic and Health Survey 2006-07, National Institute of Population Studies Islamabad, Paki‐

The incidence of low birth weight (defined <2.5 Kg by WHO) in general population reported as high as 31% from South Asia (Badshah, 2008) and 33.9% reported from West Bengal, India.

The incidence of ESRD in Pakistan and neighboring country India would be expected to be higher since poor socioeconomic status predisposes the population to a number of infectionrelated glomerulonephritides and the incidence of nephrolithiasis is higher in both countries as they fall in a ''stone belt.''(Sakhuja, 2003) In addition 6.9 million people in country are af‐ fected by diabetes with the International Diabetes Federation estimating that this number will grow to 11.5 million by 2025. With low literacy rate and poor health facilities complications and end organ failure with diabetes and hypertension are more prevalent. If the incidence of ESRD is indeed 100 patients per million population per year, this would mean 18,000 patients for a population of 180 million in Pakistan. There are very few state run dialysis centers and most of them are small units with minimal care facilities, < 5 dialysis stations. The number of patients maintained on dialysis is likely to be < 50 patients per million population since few patients can afford this form of therapy. Sindh Institute of Urology and Transplantation (SIUT) is a semi government organization in country which cater largest population of patients suf‐ fering from any kind of kidney ailment. It is running largest hemodialysis and live related renal program not only in country but the region. This organization is unique in terms of providing free health care services to all, be it pre operative preparation, surgical procedure, life long follow up and immunosupression. (www.siut.org) Because of lack of state provided health facilities number of patients seen and treated at this hospital is beyond imagination and for same reason patients do comply during follow up and long term data from this institution

Renal transplant started in country in 1979 from living related donors, initially the activity was as low as < 50 /year, which rose to about 2500 kidney transplants / year in 2007. Most of these were unrelated donor transplants done at private sector. In March 2010 Pakistan was fortunate

stan. Macro International Inc. Calverton, Maryland USA, published June 2008)

**3. Status of renal transplant in country**

278 Current Issues and Future Direction in Kidney Transplantation

is more reliable and representative.

(Pahari 1997)

Reversal of normal endocrine function has been reported within 4-6 months after renal trans‐ plantation. (Ha 1991, Ghafari 2008, McKay 2008) Thus kidney transplant offers best hope for ESRF patients who keen to conceive. First pregnancy in renal transplant recipient was reported by Murray in 1963, since then there are many published reports focusing on impact of preg‐ nancy on renal graft outcome with a conclusion that pregnancy does not have an adverse effect on graft function provided recipient has stable graft function and no adverse event happens during pregnancy. (Table)
