https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1600-6143.2005.00969.x

Reproduction and Transplantation: Report on the AST Consensus Conference on Reproductive Issues and Transplantation

With the rapid increase in the number of organs transplanted worldwide and the improved survival of transplant recipients, osteoporosis has emerged as a frequent complication of the transplantation process. In the past decade, the wider recognition of transplantation-related osteoporosis has led to a decrease in the risk of fracture for the individual patient. Nonetheless, fracture rates remain unacceptably high in transplant recipients. This presentation reviews the epidemiology of transplantation-related osteoporosis, the factors contributing to the pathogenesis of this complication, and the evaluation, prevention, and treatment options available for kidney, liver, lung, and heart transplant recipients.

/pdf/osteoporosis-after-solid-organ-transplantation-2p5dk6kz55.pdf

Osteoporosis after Solid Organ Transplantation

https://www.ackdjournal.org/article/S1548-5595(07)00003-1/pdf

Sexual Function in Chronic Kidney Disease

Reproductive success is a common, expected outcome for male and female recipients of solid-organ transplants. Men can father children, and women can become pregnant and carry the fetus to delivery. There are, however, important maternal and fetal complications that need to be considered to provide optimal care to the mother and her infant. Although pregnancy is common after the transplantation of all solid organs, guidelines for optimal counseling and clinical management are limited. This review discusses information to help the physician counsel the kidney transplant recipient about risks of pregnancy for the mother and the fetus and provides information to help guide treatment of the pregnant transplant recipient.

/pdf/pregnancy-after-kidney-transplantation-4740jj3b8h.pdf

Pregnancy after Kidney Transplantation

Gonadal dysfunction is a frequent finding in men with chronic kidney disease and with end-stage renal dis- ease. Testosterone deficiency, usually accompanied by elevation of serum gonadotropin concentrations, is present in 26-66% of men with different degrees of re- nal failure. Uremia-associated hypogonadism is multi- factorial in its origin, and rarely improves with initiation of dialysis, although it usually normalizes after renal transplantation. Experimental and clinical evidence suggests that testosterone may have important clinical implications with regards to kidney disease progres- sion, derangements in sexual drive, libido and erec- tile dysfunction, development of anemia, impairment of muscle mass and strength, and also progression of atherosclerosis and cardiovascular disease. Addition- ally, low testosterone levels in hemodialysis patients have been associated with increased mortality risk in some studies. Currently, we count with available ther- apeutic options in the management of uremic hypogo- nadism, from optimal delivery of dialysis and adequate nutritional intake, to hormone replacement therapy with different testosterone preparations. Other poten- tial options for treatment include the use of antiestro- gens, dopamine agonists, erythropoiesis-stimulating factors, vitamins, essential trace elements, chorionic gonadotropin and renal transplantation. Potential ad- verse effects of androgen replacement therapy in pa- tients with kidney disease comprise, however, eryth- rocytosis, prostate and breast cancer growth, reduced fertility, gynecomastia, obstructive sleep apnea and fluid retention. Androgen preparations should be used with caution with stringent monitoring in uremic men. Although there are encouraging data suggesting plau- sible benefits from testosterone replacement therapy, further studies are needed with regards to safety and effectiveness of this therapy.

Gonadal dysfunction in men with chronic kidney disease: clinical features, prognostic implications and therapeutic options

OBJECTIVE

To assess the effect of successful renal transplantation on semen variables, sexual function and sex hormone profiles in a clinical trial.



PATIENTS AND METHODS

Thirty patients on haemodialysis underwent renal transplantation; before and after surgery, their sperm density, motility and morphology were analysed, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin and testosterone levels measured and compared, and sexual function assessed using an abbreviated version of the International Index of Erectile Function (IIEF), with a successful outcome defined as a level of satisfaction of 4 or 5 on a 5-point scale. The paired t-test was used to assess the statistically significance of differences in all analyses.



RESULTS

Sperm motility improved significantly (P < 0.001) but there were no significant changes in morphology or density (P = 0.33 and 0.068, respectively). Testosterone levels increased and FSH, LH and prolactin decreased significantly (P < 0.05) after renal transplantation. The IIEF showed that of the 30 patients, 14 were impotent before surgery and only six remained so afterward (P < 0.05).



CONCLUSION

Although sperm morphology and density did not improve after renal transplantation, there were highly significant changes in sperm motility. Hormonal levels in patients on haemodialysis improved after transplantation and returned to nearly normal; sexual function was also significantly better. Further studies are needed to confirm these results.

R. Zohrevand

Papers

Effect of renal transplantation on sperm quality and sex hormone levels.

Effect of renal transplantation on sperm quality and sex hormone levels