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Kang J, Tian J, Lu Y, Song Y, Liu X. Erectile function after kidney transplantation: a meta-analysis. Transl Androl Urol 2020; 9:1967-1979. [PMID: 33209661 PMCID: PMC7658109 DOI: 10.21037/tau-20-604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Erectile dysfunction (ED) is common in patients with end-stage renal disease (ESRD). Whether kidney transplantation can improve erectile function in patients with ESRD is still controversial. We conducted a meta-analysis on the relationship between kidney transplantation and erectile function. Methods A literature search was conducted on PubMed, Embase, Cochrane Library, and Web of Science until May 31, 2019. Primary outcomes were ED prevalence and each domain score of the International Index of Erectile Function (IIEF) questionnaire. We used age-matched dialysis patients or patients before kidney transplantation as a control group and compared them to kidney transplant recipients. Results A total of 9 articles were finally enrolled in the study. Compared with the control group, the kidney transplantation group had a lower prevalence of ED (OR 0.49, 95% CI: 0.28–0.86) and higher domain scores for erectile function (SMD 0.53, 95% CI: 0.12–0.94) and sexual desire (SMD 1.19, 95% CI: 0.11–2.27). While there were no significant variations in domain scores for orgasmic function (SMD 0.27, 95% CI: −0.10–0.63), intercourse satisfaction (SMD 0.26, 95% CI: −0.10–0.61), and overall satisfaction (SMD 0.17, 95% CI: −0.21–0.56). Patients in the kidney transplantation group had higher serum testosterone (SMD 1.20, 95% CI: 0.86–1.54) and lower prolactin (SMD −1.46, 95% CI: −2.22 to −0.69) and luteinizing hormone (SMD −0.97, 95% CI: −1.39 to −0.55). Conclusions Kidney transplantation may be associated with improved erectile function in patients with ESRD. This may be attributable to the correction of endocrine hormone disorders in patients after kidney transplantation.
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Affiliation(s)
- Jiaqi Kang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jia Tian
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yi Lu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuxuan Song
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
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Reinhardt W, Kübber H, Dolff S, Benson S, Führer D, Tan S. Rapid recovery of hypogonadism in male patients with end stage renal disease after renal transplantation. Endocrine 2018; 60:159-166. [PMID: 29392618 DOI: 10.1007/s12020-018-1543-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/19/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE End stage renal disease (ESRD) in male patients is associated with a high prevalence of hypogonadism. After renal transplantation (RTx) an improvement in gonadal function is often observed. However, the time course of changes in pituitary-gonadal axis after RTx and the influence of renal function, age and anthropometric parameters are not well characterized. We prospectively evaluated pituitary-gonadal axis in male patients with ESRD before and after RTx for up to 1 year. METHODS Ninety-seven male patients with ESRD were consecutively investigated on day of surgery and 1, 3, 6, and 12 months after RTx. Time course of changes in sex hormones (total testosterone ((TT)), calculated free testosterone ((cfT)), estradiol (E2), LH, FSH and prolactin), and interdependence with renal function, age, anthropometric factors, cause of ERDS, time on dialysis, and transplant associated factors were analyzed. RESULTS Hypogonadism (TT < 8 nmol/l) was present in 40% of pts prior to RTX and in only 18% at 1 year after RTX. Recovery from hypogonadism was significantly higher in pts < 50 years and occurred within 3 months. RTx resulted in a decrease in E2/T ratio starting at 1 month and suggesting a shift from estrogen to testosterone production. BMI and waist circumference had the similar impact on T levels after successful RTx compared to patients without renal disease. No specific impact on recovery of hypogonadism was found for time on dialysis prior to RTx and living or cadaver transplantation. CONCLUSIONS Successful RTx is associated with a rapid recovery from hypogonadism within 3 months preceeded by improvement in renal function particularly in patients younger than 50 years.
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Affiliation(s)
- W Reinhardt
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| | - H Kübber
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - S Dolff
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - S Benson
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - D Führer
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - S Tan
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Sarier M, Tekin S, Duman İ, Yuksel Y, Demir M, Alptekinkaya F, Guler M, Yavuz AH, Kosar A. Results of transurethral resection of the prostate in renal transplant recipients: a single center experience. World J Urol 2017; 36:99-103. [DOI: 10.1007/s00345-017-2094-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/28/2017] [Indexed: 11/24/2022] Open
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Lo JC, Beck GJ, Kaysen GA, Chan CT, Kliger AS, Rocco MV, Chertow GM. Hyperprolactinemia in end-stage renal disease and effects of frequent hemodialysis. Hemodial Int 2016; 21:190-196. [PMID: 27774730 DOI: 10.1111/hdi.12489] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION End-stage renal disease is associated with elevations in circulating prolactin concentrations, but the association of prolactin concentrations with intermediate health outcomes and the effects of hemodialysis frequency on changes in serum prolactin have not been examined. METHODS The FHN Daily and Nocturnal Dialysis Trials compared the effects of conventional thrice weekly hemodialysis with in-center daily hemodialysis (6 days/week) and nocturnal home hemodialysis (6 nights/week) over 12 months and obtained measures of health-related quality of life, self-reported physical function, mental health and cognition. Serum prolactin concentrations were measured at baseline and 12-month follow-up in 70% of the FHN Trial cohort to examine the associations among serum prolactin concentrations and physical, mental and cognitive function and the effects of hemodialysis frequency on serum prolactin. FINDINGS Among 177 Daily Trial and 60 Nocturnal Trial participants with baseline serum prolactin measurements, the median serum prolactin concentration was 65 ng/mL (25th-75th percentile 48-195 ng/mL) and 81% had serum prolactin concentrations >30 ng/mL. While serum prolactin was associated with sex (higher in women), we observed no association between baseline serum prolactin and age, dialysis vintage, and baseline measures of physical, mental and cognitive function. Furthermore, there was no significant effect of hemodialysis frequency on serum prolactin in either of the two trials. DISCUSSION Serum prolactin concentrations were elevated in the large majority of patients with ESRD, but were not associated with several measures of health status. Circulating prolactin levels also do not appear to decrease in response to more frequent hemodialysis over a one-year period.
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Affiliation(s)
- Joan C Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Gerald J Beck
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - George A Kaysen
- Division of Nephrology, Department of Medicine, University of California Davis, Davis, California, USA
| | - Christopher T Chan
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alan S Kliger
- Division of Nephrology, Department of Medicine, Yale School of Medicine and Yale New Haven Health System, New Haven, Connecticut, USA
| | - Michael V Rocco
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Testicular Function, Semen Quality, and Fertility in Young Men After Renal Transplantation During Childhood or Adolescence. Transplantation 2014; 98:987-93. [DOI: 10.1097/tp.0000000000000173] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hamdi SM, Walschaerts M, Bujan L, Rostaing L, Kamar N. A prospective study in male recipients of kidney transplantation reveals divergent patterns for inhibin B and testosterone secretions. Basic Clin Androl 2014; 24:11. [PMID: 25780584 PMCID: PMC4349688 DOI: 10.1186/2051-4190-24-11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/06/2014] [Indexed: 01/15/2023] Open
Abstract
Background Male patients with chronic kidney disease often exhibit the biological and clinical hallmarks of an abnormal hypothalamo–pituitary–gonadal axis. It is known that dialysis does not reverse this impaired endocrine status; however, the impact of kidney transplantation (KT) is still controversial. The aim of our study was to investigate the levels of serum gonadotropins, testosterone, and inhibin B during dialysis and after KT. Methods A longitudinal and prospective single center study was led in an academic setting. Blood hormones levels were assayed by immunoassays in 53 men (mean age: 37 years) receiving dialysis (T0) and at 6 months post-KT (T180). These data were compared with those from 46 fertile semen donors (mean age: 37 years). The main outcome measure was the between-groups differences in hormones levels. A second criterion was the comparison of T0 and T180 hormones levels according to the immunosuppressive regimen. Results For patients ongoing dialysis, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) mean levels were high, whereas testosterone and inhibin B mean levels remained normal. After KT, LH levels returned to normal whereas FSH was significantly increased. Testosterone levels remained normal whereas inhibin B levels significantly decreased. We found that the combination tacrolimus plus mycophenolic acid significantly decreased post-KT inhibin B levels. Moreover, we found that pre-graft inhibin-B level was independent of testosterone and could predict low post-operative inhibin B level with a sensitivity of 77% and a specificity of 92%. Conclusions Our study suggests that endocrine secretions of Leydig and Sertoli cells are differently impacted by dialysis, KT and immunosuppressive regimen raising new issues to explore.
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Affiliation(s)
- Safouane M Hamdi
- Groupe de Recherche en Fertilité Humaine, EA 3694, Hôpital Paule de Viguier, Toulouse, F-31000 France ; Université Paul-Sabatier, Toulouse, F-31000 France
| | - Marie Walschaerts
- Groupe de Recherche en Fertilité Humaine, EA 3694, Hôpital Paule de Viguier, Toulouse, F-31000 France ; Université Paul-Sabatier, Toulouse, F-31000 France
| | - Louis Bujan
- Groupe de Recherche en Fertilité Humaine, EA 3694, Hôpital Paule de Viguier, Toulouse, F-31000 France ; Université Paul-Sabatier, Toulouse, F-31000 France
| | - Lionel Rostaing
- Université Paul-Sabatier, Toulouse, F-31000 France ; Département de Néphrologie et Transplantation d'Organes, CHU Toulouse, Toulouse, F-31000 France
| | - Nassim Kamar
- Université Paul-Sabatier, Toulouse, F-31000 France ; Département de Néphrologie et Transplantation d'Organes, CHU Toulouse, Toulouse, F-31000 France
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Low testosterone at time of transplantation is independently associated with poor patient and graft survival in male renal transplant recipients. J Urol 2014; 192:1168-71. [PMID: 24704018 DOI: 10.1016/j.juro.2014.03.102] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE Low testosterone is common in men with renal disease and it increases the risk of death in those on dialysis. We studied serum testosterone at transplantation and correlated it with patient and graft outcomes. MATERIALS AND METHODS We identified serum samples collected and frozen at the time of transplantation in male recipients of primary kidney transplants done more than 6 years ago at our institution. In 197 recipients there was sufficient serum to determine total testosterone. We analyzed contingency outcomes by the Fisher exact test, continuous values by the Student t-test and survival by the Gehan-Breslow-Wilcoxon test. RESULTS Mean patient age was 48.9 years (range 14 to 75). There were 100 living and 97 cadaveric donors, and 53 recipients (27%) had diabetes. Mean ± SD serum testosterone was 477 ± 251.3 ng/dl (range 48 to 2,013). Testosterone was low (less than 220 ng/dl) in 24 patients. Age did not correlate with testosterone. Low testosterone recipients had worse 1-year patient survival (75% vs 95%, p = 0.003), 3-year patient survival (62.5% vs 86.1%, p = 0.008), 1-year graft survival (62.5% vs 92.4%) and 3-year graft survival (50% vs 76.3%, p = 0.01). Survival curves showed significantly worse patient survival (p = 0.004) and graft survival (p = 0.02) for low testosterone. On multivariable analysis low testosterone was independently associated with patient death (HR 2.27, 95% CI 1.19-4.32) and graft loss (HR 2.05, 95% CI 1.16-3.62). CONCLUSIONS Low testosterone at transplantation is associated with patient death and graft loss. If due to causality, testosterone therapy may impact survival. Without causality low testosterone may still be a marker for posttransplant risk.
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Park M, Koo H, Lee B. Characteristics of Testosterone Deficiency Syndrome in Men With Chronic Kidney Disease and Male Renal Transplant Recipients: A Cross-Sectional Study. Transplant Proc 2013; 45:2970-4. [DOI: 10.1016/j.transproceed.2013.08.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Cavanaugh TM, Schoenemen H, Goebel J. The impact of sirolimus on sex hormones in male adolescent kidney recipients. Pediatr Transplant 2012; 16:280-5. [PMID: 22372519 DOI: 10.1111/j.1399-3046.2012.01647.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
While it is known that sirolimus affects sex hormones in adult kidney transplant patients, there is a scarcity of data on its effects on sex hormone levels in adolescent kidney recipients. The objective of this study is to describe the impact of sirolimus on the sex hormones in this patient population. This is a retrospective review of male adolescent renal transplant patients transitioned to sirolimus. Baseline and subsequent annual testosterone levels were collected. Linear regression was undertaken to determine the predictors of testosterone levels. Four African Americans and 11 Caucasians, median age of 15 yr (11-18) in 2008, were included. Mean time post-transplant was 81 ± 37 months. Mean testosterone values were the following: 336 ± 135 ng/dL (n = 8) at baseline, 349 ± 130 ng/dL (n = 15) one yr later, and 360 ± 132 ng/dL (n = 13) two yr later (normal range for adult males: 350-970 ng/dL). Seven (47%) patients experienced a decrease in testosterone levels. Time on sirolimus was associated with decreased testosterone (r = 0.643, p = 0.010). Testosterone levels in pubertal male kidney transplant recipients on sirolimus may be suppressed, especially if they have been treated with sirolimus for several years. These data need to be confirmed in a larger study.
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Affiliation(s)
- Teresa M Cavanaugh
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH 45267, USA.
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VAN EPS CAROLYN, HAWLEY CARMEL, JEFFRIES JANINE, JOHNSON DAVIDW, CAMPBELL SCOTT, ISBEL NICOLE, MUDGE DAVIDW, PRINS JOHANNES. Changes in serum prolactin, sex hormones and thyroid function with alternate nightly nocturnal home haemodialysis. Nephrology (Carlton) 2011; 17:42-7. [DOI: 10.1111/j.1440-1797.2011.01520.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang GC, Zheng JH, Xu LG, Min ZL, Zhu YH, Qi J, Duan QL. Measurements of serum pituitary-gonadal hormones and investigation of sexual and reproductive functions in kidney transplant recipients. Int J Nephrol 2010; 2010:612126. [PMID: 21152203 PMCID: PMC2989692 DOI: 10.4061/2010/612126] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Revised: 04/27/2010] [Accepted: 06/17/2010] [Indexed: 01/29/2023] Open
Abstract
Objective. To investigate changes in serum pituitary-gonadal hormones and restoration of sexual and reproductive functions after successful kidney transplantation.
Patients and Methods. Serum pituitary-gonadal hormones before and after kidney transplantation were measured in 78 patients with end-stage renal disease (ESRD) and in 30 healthy adults. Pre- and postoperative semen specimens of 46 male recipients and 15 male controls were collected and compared. Additional 100 married kidney transplant recipients without children were followed up for 3 years to observe their sexual function and fertility.
Results. Serum PRL, LH, and T or E2 levels gradually restored to the normal ranges in all kidney transplant recipients, and sperm density, motility, viability, and morphology significantly improved in the male recipients 4 months after successful kidney transplantation (P < .05). Thirty-three male recipients (55.93%) reobtained normal erectile function, and 49 kidney transplant recipients (61.25%) had children within the 3-year follow-up period.
Conclusion. Successful kidney transplantation could effectively improve pituitary-gonadal hormone disturbance and sexual and reproductive dysfunctions of ESRD patients.
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Affiliation(s)
- Guang-Chun Wang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
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Sartorius GA, Handelsman DJ. Testicular Dysfunction in Systemic Diseases. Andrology 2010. [DOI: 10.1007/978-3-540-78355-8_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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