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

Abstract

ObjectiveTo evaluate the predictive role of the Model for End-Stage Liver Disease (MELD) score concerning changes in testosterone levels following living donor liver transplantation (LDLT) and the effects of LDLT on total testosterone and sex hormone-binding globulin (SHBG) levels, the free androgen index (FAI) and erectile function in LDLT recipients.Participants41 adult male recipients of LDLT were evaluated before transplantation and six months after LDLT.Main outcome measuresWe evaluated the effects of LDLT on total testosterone and SHBG levels, the FAI and erectile function in LDLT recipients. In this prospective study, MELD score, serum total testosterone, SHBG levels and FAI were measured in the morning of the operation day and 1 month, 3 months and 6 months after LDLT. The 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire was administered before LDLT and six months after LDLT to evaluate erectile function.ResultsThe main outcome measure was dynamic parameter changes of total testosterone, SHBG, FAI and erectile dysfunction. The mean FAI value before LDLT was 16.75±10.10. The mean FAI was significantly higher 1 month (32.75±15.56; p < 0.01), 3 months (25.23±10.26; p < 0.01) and 6 months (29.16±11.05; p < 0.01) after LDLT. Mean IIEF-5 scores significantly increased after LDLT (from 11.7±7.7 before LDLT to 14.7±7.5, p< 0.01).ConclusionsMELD score correlates with severity of hypogonadism in men with end-stage liver disease. LDLT results in a reduction in serum levels of SHBG, an increase in FAI and improvement in erectile function.

AASLD Practice Guidance: Palliative care and symptom‐based management in decompensated cirrhosis

“…[268] Nonpharmacological treatments, including sex therapy or vacuum devices, have not been tried in patients with cirrhosis, but may be a safe alternative. [269] Furthermore, a small study found that sexual satisfaction and erectile dysfunction improved after LT. [257,260] More research is needed to determine how to manage sexual dysfunction in this population, particularly among women.…”

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

“…It is important, since male patients suffering from end-stage of liver disease exhibit worse sexual function which is mirrored in hypogonadism and feminization. Among others, in these patients, testicular atrophy, decreased T level, reduced secondary sexual characteristics, muscle reduction, gynecomastia, decreased libido and fertility are frequently reported [ 24 , 30 ]. According to the latest reports, almost 50% of men with diagnosed cirrhosis, reduced spermatogenesis and peritubular fibrosis are noticed [ 33 ].…”

“…According to the latest reports, almost 50% of men with diagnosed cirrhosis, reduced spermatogenesis and peritubular fibrosis are noticed [ 33 ]. All the aforementioned symptoms may result in a regressed quality of professional, social and sexual life leading to high fatigue levels, depression or impotence [ 30 ]. Successful liver transplantation primarily saves the lives of patients suffering from end-stage liver disease but, secondly, it should improve the life quality of liver transplant recipients, among others, by restoring hormonal balance.…”

“…It may be therefore concluded that erectile function depends more predominantly on the concentration of PRL, in comparison to the levels of T or E2. It is worth mentioning that all the patients were under tacrolimus therapy, which is believed not to be a reprotoxic immunosuppressive agent [ 30 ]. Similarly, confusing results achieved by Chiang et al [ 30 ] when observing adult men aged approximately 54 years of age after one and up to six months from liver transplantation.…”

“…It is worth mentioning that all the patients were under tacrolimus therapy, which is believed not to be a reprotoxic immunosuppressive agent [ 30 ]. Similarly, confusing results achieved by Chiang et al [ 30 ] when observing adult men aged approximately 54 years of age after one and up to six months from liver transplantation. In all these men, free T level as well as T and SHBG were observed to be reduced below the norm.…”