Abstract
Patients with kidney transplantation often have a worse quality of life than the general population. One of the reasons for this, in male patients, is the high prevalence of erectile dysfunction. This is mainly due to the presence of comorbidities, surgery for kidney transplantation, adverse drug effects, psychological changes related to chronic disease, as well as hyperprolactinemia and hypogonadism. Whenever these endocrine dysfunctions occur after kidney transplantation, they must be corrected with appropriate treatment, i.e., testosterone replacement therapy. Administration of the phosphodiesterase-5 inhibitor (PDE5i) sildenafil at the recommended posology does not significantly alter the pharmacokinetics of the calcineurin inhibitors cyclosporin A or tacrolimus and does not impair kidney allograft function. Tacrolimus increases the peak concentration and prolongs the half-life of PDE5i in kidney transplant patients and, therefore, daily administration cannot be recommended due to the significant drop in blood pressure. Intracavernous injection or topical application of alprostadil can be a second-line option for the treatment of erectile dysfunction after kidney transplantation, which does not alter cyclosporine concentrations and does not deteriorate kidney function. Finally, penile prostheses can be successfully implanted following pelvic organ transplantation after eliminating the risk of infection associated with surgery.
Highlights
Impaired sexual function is very common in end-stage renal disease (ESRD) patients, with a prevalence of 60–90% in both genders [1,2,3]
This suggests that restoration of the glomerular filtration rate (GFR) after transplantation may improve erectile function, the reduction in erectile dysfunction (ED) severity and prevalence might depend on the predominant etiological mechanism [2]
For severely impaired patients (CLcr < 30 mL/min) and patients with ESRD undergoing dialysis, a 5-mg total dose in 72 h is recommended
Summary
Impaired sexual function is very common in end-stage renal disease (ESRD) patients, with a prevalence of 60–90% in both genders [1,2,3]. Improvement of sexual dysfunction has been reported after kidney transplantation [4,5,6], some studies have shown that this condition can persist even after successful transplantation [7,8]. In a systematic review and meta-analysis of 50 studies, the rate of erectile dysfunction (ED) in patients with chronic kidney disease (CKD) was shown to be 75%, whereas it decreased to 59% in kidney transplantation recipients (KTRs). This suggests that restoration of the glomerular filtration rate (GFR) after transplantation may improve erectile function, the reduction in ED severity and prevalence might depend on the predominant etiological mechanism [2]. Because of the paucity of the studies, we aim to highlight the best practice in the treatment of ED in KTRs, underlying that sexual dysfunction is an underestimated topic by nephrologists in both men and women with CKD, after kidney transplantation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
