Assessing men with erectile dysfunction before and after living donor liver transplantation in real-world practice: Integrating laboratories into clinical settings

Liver transplantation improves erectile function in patients with end-stage liver disease: a systematic review and meta-analysis

Background

Liver transplantation (LT) has been recognized as the most effective therapy for end-stage liver disease (ESLD). However, the question of whether LT can improve erectile function in patients with ESLD remains controversial. Therefore, we conducted this meta-analysis to evaluate the association between LT and erectile dysfunction (ED).

Methods

According to the PRISMA guidelines, studies were included after conducting searches in four databases from March 2024 onwards. These databases included PubMed, Cochrane Library, Web of Science, and Embase. The primary outcome of interest was to compare the International Index of Erectile Function (IIEF) scores between patients after and before LT. Standardized mean differences (SMDs) and their corresponding 95% confidence intervals (CIs) were utilized to assess the relationship between LT and ED.

Results

The results showed that the LT group had higher IIEF-5 domain scores for erectile function compared to the control group (SMD =-0.31, 95% CI: -0.53 to -0.09), P=0.007). No heterogeneity or publication bias was detected in the results. Additionally, the IIEF-15 domain score was also found to be improved after LT. Specifically, the LT group had higher domain scores for erectile function (SMD =-0.77, 95% CI: -1.07 to -0.48, P<0.001), orgasmic function (SMD =-0.82, 95% CI: -1.12 to -0.52, P<0.001), sexual desire (SMD =-0.89, 95% CI: -1.19 to -0.59, P<0.001), intercourse satisfaction (SMD =-0.92, 95% CI: -1.22 to -0.62, P<0.001), and overall satisfaction (SMD =-0.87, 95% CI: -1.17 to -0.57, P<0.001).

Conclusions

It is suggested by our meta-analysis that LT may contribute to improvements in erectile function among men with ESLD. This improvement may be related to the remarkable improvement in endocrine hormone disorders observed after LT. However, future studies with better designs and larger sample sizes are still needed to confirm our conclusions. Additionally, attention to erectile function before and after surgery in patients with liver failure is crucial.

Changes in post-transplant serum testosterone levels in men undergoing lung transplantation: a pilot study using the TriNetX Research Network

Hypogonadism is understudied in men requiring solid organ transplants, particularly among lung transplant recipients. Improvement in serum testosterone levels has been reported in kidney and liver transplantation. Using the TriNetX Research Network, we performed a retrospective cohort study to evaluate the incidence of peri-transplant hypogonadism and the natural course of serum testosterone following successful lung transplantation. Men aged ≥ 18 with a lung transplant and total testosterone drawn within one year pre- and post-transplant were included. Men with receipt of testosterone therapy were excluded. A low testosterone (<300 ng/dL) and normal testosterone (≥300 ng/dL) cohort was created before employing descriptive and analytic statistics to investigate the incidence of peri-transplant hypogonadism and the change in serum testosterone levels following lung transplantation. In our entire cohort, lung transplantation was not associated with a significant increase in post-transplant serum testosterone (329.86 ± 162.56 ng/dL pre-transplant and 355.13 ± 216.11 ng/dL post-transplant, p = 0.483). The number of men with low testosterone decreased by 9.8% following lung transplantation but was not significant, p = 0.404. In this pilot study, no significant change in the number of hypogonadal men nor serum testosterone levels was observed among men undergoing lung transplantation.

Chronic liver diseases and erectile dysfunction

Chronic liver diseases (CLDs) are characterized by progressive necrosis of hepatocytes, which leads to liver fibrosis and cirrhosis, and ultimately liver dysfunction. The statistics of 2020 shows that the number of patients with CLDs, including chronic hepatitis, fatty liver, and cirrhosis, may exceed 447 million in China. The liver is a crucial organ for the metabolism of various substances, including sex hormones and lipids. CLDs frequently result in abnormalities in the metabolism of sex hormones, glucose, and lipids, as well as mental and psychological illnesses, all of which are significant risk factors for erectile dysfunction (ED). It has been reported that the prevalence of ED in male patients with CLDs ranges from 24.6 to 85.0%. According to a survey of Caucasians, liver transplantation may improve the erectile function of CLDs patients with ED. This finding supports the link between CLDs and ED. In addition, ED is often a precursor to a variety of chronic diseases. Given this correlation and the significant prevalence of CLDs, it is important to evaluate the epidemiology, risk factors, etiology, and treatment outcomes of ED in male patients with CLDs, expecting to attract widespread attention.

Gonadal dysfunction in male patients with Budd Chiari syndrome and its reversibility with treatment

BACKGROUND AND AIMS

Budd Chiari syndrome (BCS) commonly affects adolescents and adults. With improved survival, important quality-of-life parameters such as sexual life and fertility become more relevant. This study was aimed to assess the gonadal function in male patients with BCS and the effect of treatment on gonadal function.

METHODS

Thirty male patients with newly diagnosed BCS were prospectively assessed for the presence of gonadal dysfunction. Erectile function was assessed using standardized International Index of Erectile Function questionnaire (IIEF). Follicular stimulating hormone (FSH), luteinizing hormone (LH), sex hormone-binding globulin (SHBG), estradiol, total testosterone (TT), calculated free testosterone (cFT), calculated bioavailable testosterone (cBT), sperm count, and sperm motility were compared at baseline and at 6 months of treatment for the assessment of gonadal function.

RESULTS

Sixteen (53.3%) out of 30 patients were sexually active at the time of study and 5/16 (31%) had erectile dysfunction. Hypogonadotropic hypogonadism (HH) was the most common pattern seen in 50% cases followed by hypergonadotropic hypogonadism (HyH) in 23% cases. 27% patients had eugonadism. At 6 months of treatment, 60% of patients in HH group became eugonadal as compared to only 14% in HyH group. Proportion of patients with erectile dysfunction reduced (5/16 vs 1/16) after 6 months of therapy. The improvement in sperm count and sperm motility was not significant.

CONCLUSION

Gonadal dysfunction is common in male patients with BCS. HH remains the most common type of hypogonadism BCS and the type which improves significantly after treatment.

Prevalence and risk factors of erectile dysfunction in patients with liver cirrhosis: a systematic review and meta-analysis

BACKGROUND AND AIMS

Liver cirrhosis is associated with an increased risk of developing erectile dysfunction (ED). The aim of this systematic review and meta-analysis was to evaluate the prevalence of ED and its risk factors in male patients with liver cirrhosis.

METHODS

A systematic search of PubMed (Medline), EMBASE, OVID Medline, the Cochrane Library, and other databases was performed for this review. Two investigators reviewed the abstracts obtained from the search and selected manuscripts for full-text review. The event rates were calculated with random-effects model and quality effects model.

RESULTS

Fourteen studies evaluating ED with the International Index of Erectile Function (IIEF) scores were selected. A total of 770 patients with liver cirrhosis were analyzed. The prevalence of ED in cirrhotic patients was 79% [decompensated: 88.4%, CI 35.95-70.84%, I² heterogeneity 85%; compensated: 53.6%, CI 77.64-32%, I² heterogeneity 80%]. Through a meta-regression analysis, we discovered that the presence of decompensation, use of beta-blocker and diuretics were related with ED. In addition, risk factors for ED included high body mass index [odds ratio (OR) 1.13, 95% CI 1.01-1.26], advanced Child-Pugh class (OR 2.29, 95% CI 1.12-4.72), MELD score (OR 1.19, 95% CI 1.05-1.35), diabetes (OR 3.44, 95% CI 1.38-8.57), and hypertension (OR 8.24, 95% CI 1.62-41.99).

CONCLUSION

ED is relatively common in male patients with cirrhosis, and presence of risk factors increases the prevalence of ED.

CLINICAL TRIAL NUMBER

PROSPERO (International Prospective Register of Systematic Reviews), CRD42020220411.

Sexual Dysfunction in Patients With Chronic Gastrointestinal and Liver Diseases: A neglected Issue

INTRODUCTION

Normal sexual activity is an important determinant of quality of life. Unfortunately, several chronic health disorders are associated with an impaired sexual function.

OBJECTIVE

To provide coverage of the current literature on prevalence and pathophysiology of sexual dysfunction in patients with gastrointestinal and liver disorders METHODS: A Comprehensive review of the literature on the prevalence of sexual dysfunction in chronic gastrointestinal and liver disorders, assessing the underlying mechanism (s) was performed.

RESULTS

Many gastrointestinal disorders, either functional or organic, are associated with some degree of sexual dysfunction. The main pathogenic mechanisms are: (i) the disease itself causing fatigue, anxiety or depression with a potential alteration of self-esteem; (ii) worry of transmitting a potential infectious agent through sexual activity; (iii) alteration of the endocrine mechanisms which are necessary for normal sexual functioning; (iv) chronic pro- inflammatory conditions which may cause endothelial dysfunction and abnormal vascular responses; (v) iatrogenic.

CONCLUSION

Based on this review, a thorough evaluation of sexual function through validated questionnaires and/or psychological interviews with patients with chronic gastrointestinal disorders should be part of the clinical assessment in order to timely diagnose and possibly treat sexual dysfunction in this clinical setting. L Romano, L Granata, F Fusco, et al. Sexual Dysfunction in Patients With Chronic Gastrointestinal and Liver Diseases: A neglected Issue. Sex Med Rev 2021;XX:XXX-XXX.

Hormonal (Im)Balance and Reproductive System’s Disorders in Transplant Recipients—A Review

Simple Summary

Nowadays, the average human life expectancy is increasing. This applies to both healthy and chronically ill people. It is possible due to improvements in technology, living conditions, and better, more accessible medical care. As the number of patients with end-stage organ failure increases and due to great progress in modern transplantology, every year the number of transplantations rises worldwide. Organ transplantation is not only an ultimate form of therapy but also, especially nowadays, a life-saving procedure. Patients who have undergone transplantation need to face the problem of long-term immunosuppressive therapy on a daily basis, which prolongs the proper function of the grafted organ and prevents the development of graft-versus-host disease. On the other hand, numerous side effects are associated with the usage of these medicaments, among these are disturbances in sex-related hormones, therefore influencing fertility.

Abstract

The rising need for treatment of end stage of organ failure results in an increased number of graft recipients yearly. The most commonly transplanted organs are kidney, heart, liver, bone marrow, lung and skin. The procedure of transplantation saves and prolongs the lives of chronically ill patients or at least improves the quality. However, following transplantation recipients must take immunosuppressive drugs on a daily basis. Usually, the immunosuppressive therapy comprises two or three drugs from different groups, as the mechanism of their action varies. Although the benefits of intake of immunosuppressants is undeniable, numerous side effects are associated with them. To different extents, they are neurotoxic, nephrotoxic and may influence the function of the reproductive system. Nowadays, when infertility is an urgent problem even among healthy pairs, transplant recipients face the problem of disturbance in the hypothalamic−pituitary axis. This review will provide an overview of the most common disturbances among the concentration of sex-related hormones in recipients of both sexes at different ages, including sexually immature children, adults of reproductive age as well as elderly women and men. We have also focused on the numerous side effects of immunosuppressive therapy regarding function and morphology of reproductive organs both in males and females. The current review also presents the regimen of immunosuppressive therapy and time since transplantation.