Prospective Study on Sexual Dysfunction in Male Chinese Liver Transplant Recipients

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    Erectile sex ED zeni defined as the inability to achieve and maintain an erection sex to permit satisfactory sexual intercourse Lue, International Journal of Impotence Research15— Zeni 1. sex dating

    In patients with end-stage liver disease, hypogonadism and erectile dysfunction are often seen. This study was to determine the incidence of erectile dysfunction before and after liver transplantation LT with correlation to change in sex hormone levels from a Chinese cohort. The study period was from January to December Adult male patients with end-stage liver disease enlisted for LT were recruited on informed written consent.

    All recruited patients were to complete a cross-sectional cohort questionnaire—International Index of Erectile Function, version 5 IIEF5 —and to receive serum sex hormone checks before and after LT. Twenty-eight patients who underwent LT were included in the analysis.

    This study demonstrated that there was improvement in sex hormone levels after LT, namely, normalization of estradiol level and lowering of prolactin and progesterone levels. However, improvement in sex hormone levels did not translate into improvement of erectile dysfunction. Sexual dysfunction is characterized by disturbances in sexual desire and in the psychophysiological changes associated with the sexual sex cycle in men and women.

    Erectile dysfunction ED is defined as the inability to achieve and maintain an erection sufficient to permit zeni sexual intercourse Lue, In patients with end-stage liver disease, hypogonadism and signs of feminization can be seen. Studies on Western populations reported that there was improvement in sex hormone sex after successful liver transplantation LT.

    Risk factors for ED in LT patients are largely unknown. A better understanding of coexisting chronic sex conditions that increase the risk of ED is essential to developing adaptive strategies.

    Reports on Chinese patients on this area are lacking. It is hoped that the current study will fill sex void in the literature. Those with end-stage liver disease who were eligible for LT deceased-donor LT or living-donor LT were recruited on written informed consent. Patients with fulminant hepatic failure, in hepatic coma, on anti-ED medication e. Recruited patients were allowed to withdraw from the study at any time.

    The secondary sex was to determine the change of sex hormone disturbances by measuring sex hormones assay OH progesterone, prolactin, total and free testosterone, thyroid-stimulating hormone, beta-estradiol, and sex-hormone-binding globulin [SHBG] before and after at 6 months LT.

    A dedicated nurse specialist interviewed all recruited patients, and an IIEF5 questionnaire, a validated Chinese version, was completed by direct questioning in a single room.

    The patients were interviewed on their first outpatient visit and at 1 month and 6 months after LT. At the same time, blood was taken for check of sex hormones after each interview. All patients were followed up at the outpatient clinic weekly after LT for the first 3 months.

    Frequency of subsequent visits was determined according to clinical needs. Only results of patients who had undergone LT were included for further analysis. Zeni and post-LT total IIEF5 scores and sex hormone assays were compared by paired-sample t test or Wilcoxon signed-rank test where appropriate.

    Linear regression was used to explore possible factors affecting IIEF5 score upon inclusion. SPSS, version 20, was used for statistical analysis. IIEF5 score is the sum of the ordinal responses to the five items. Score 22— no ED.

    Score 17— mild ED. Score 12— mild-to-moderate ED. Score 8— moderate ED. Fifty patients were recruited during the period from January to December Among the 50 patients, 29 had LT done during the study period 18 had deceased donors and 11 had live donors3 died while waiting, 13 were delisted due to disease deterioration, and 5 were still waiting Figure 1.

    One of zeni 29 LT recipients received the operation at another center. Five recipients died after the operation.

    After excluding 1 in-hospital postoperative mortality, 28 LT recipients were included for analysis. The median waiting time to LT was 8. Flow diagram of patient inclusion. Figure 2 is a plot of IIEF5 scores at different time points in the study. The median IIEF5 score of the patients included for analysis was identified to be low preoperatively and postoperatively. The preoperative median score was 11 range, zenithe score at postoperative 1 month was 4 range, zeniand the score at postoperative 6 months was 9 range, 1— After excluding patients who did not have LT done and the one in-hospital death, comparison of sex hormone levels and IIEF5 total scores at three different time points before LT and at 1 month and 6 months after LT was made Table 2.

    The only significant change was at the first month after LT, where the score was lowest. Only 5 patients Five patients failed to complete the questionnaires at Month 6 because of hospitalization or missing from follow-up. The median values of preoperative serum sex hormone levels of the 28 LT recipients are listed in Table 2. Eight patients did not have their sex hormone levels measured.

    Eleven patients Prolactin level was elevated in two patients 4. Nine patients Almost half of the patients After LT, there was a significant decrease in prolactin and beta-estradiol levels.

    The median prolactin level dropped from The median level of beta-estradiol dropped from There was no significant change in total testosterone level Finally, Sex progesterone level was elevated insignificantly from 5.

    Linear regression was performed for various factors to explore any relationship with IIEF5 score. The factors were age, MELD score, zeni time at inclusion, and premorbidity diabetes mellitus, hypertension, and ischemic heart disease. ED is more prevalent in Asian regions. Yet the topic is poorly studied, with very few published papers. While many health-care providers focus on survival and complications after LT, sexual health in post-LT patients is often ignored. Sexual health is one of the important aspects contributing to satisfactory quality of life after LT.

    Evidence is particularly scarce in Asian regions, even for the general population. The current study is one of the first in Asia to explore the change in sex hormone levels before and after LT and the possible correlation with ED. Prolactin has been known to be one of the hormones affecting sexual function.

    This in turn results in hypogonadotropic hypogonadism Lue, In patients with liver failure, there is a disturbance in amino acid metabolism, causing an increase in circulating aromatic amino acids.

    Therefore, it was not surprising in this study to see a significant decrease in prolactin level when liver function returned to normal after LT. With decreased metabolism of estrogen by the liver, the increase in estrogen level inhibits the production of luteinizing hormone by the pituitary gland, and thus the reduction in production of testosterone Sex et al.

    In this study, estrogen level decreased significantly after liver function returned, which reflected the normalization of estrogen metabolism. Despite the significant improvement in prolactin and beta-estradiol levels, there was no significant improvement in total or free testosterone level at Month 6.

    Another Austrian group also published similar data in the s Madersbacher et al. The reason behind such difference is still unknown, but it is postulated that the relatively higher rate of LT and shorter waiting time in European countries Global Observatory on Donation and Transplantation data, may contribute to a quicker recovery in gonadal function. Whether preexisting gonadal alteration by toxic metabolites is fully reversible after LT is a question yet to be answered.

    The role of immunosuppressive therapy is also important. Possible effects of immunosuppressants on sexual function are also being studied Kaczmarek et al. Most LT recipients at this center were given tacrolimus monotherapy, and its effect on gonadal function is not clear. This study is mainly limited by its small number of participants and relatively short observation period after the operation.

    Unexpectedly, most of the patients had normal preoperative testosterone levels and were included into the study, which might be the reason why there was insignificant change in testosterone level and IIEF5 score. Future research on this topic can consider including measurement at 6 months and 1 year after Zeni to observe any delayed improvement in sexual function.

    ED is a multifactorial condition, where psychological, physical, and social factors all come into play Lue, ; Nicolosi, Zeni, et al. Liver disease affects a patient sex many aspects, such as hormonal imbalance, psychological stress of chronic illness, and even family tension while considering organ donation.

    After LT, despite normalization of liver function and improvement in sex hormone levels, erectile function is still under the influence of a number of factors, including complications from the operation, wound pain, and medications.

    Multidisciplinary zeni is paramount in helping this group of patients. However, improvement in sex hormone levels did not sex into improvement of ED. Supplemental Material: Supplemental material zeni this article is available online.

    National Center for Biotechnology InformationU. Am J Mens Health. Published online Mar 5. Author information Article notes Copyright and License zeni Disclaimer. Email: moc. Abstract In patients with end-stage liver disease, hypogonadism and erectile dysfunction are often seen.

    Keywords: liver transplantation, erectile dysfunction, hypogonadism, end-stage liver disease, sexual dysfunction, treatment outcome. Data Collection A dedicated nurse specialist interviewed all recruited patients, sex an IIEF5 questionnaire, a validated Chinese version, was completed by direct questioning in a single room. Data Analysis Only results of patients who had undergone LT were included for further analysis.

    Results Fifty patients were recruited during the period from January to December

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