Sexual health after orthotopic liver transplantation

Abstract

Many studies have reported improved health-related quality of life outcomes after orthotopic liver transplantation; however, specific research regarding sexual health in liver transplant recipients is limited. We surveyed liver transplant recipients to determine the prevalence of sexual dysfunction. Of the 320 adult liver transplant recipients surveyed by mailed questionnaire, 150 responded (42%). The median age was 54 years. A total of 62% of respondents were male, and 93% were at least 1 year after transplantation. Thirty-six respondents (24%) reported sexual dysfunction before transplantation; this persisted in 22 patients (15%) after transplantation. A total of 48 respondents (32%) reported de novo sexual dysfunction after transplantation. After transplantation, 23% of male and 26% of female respondents reported decreased libido, and 33% of men and 26% of women reported having difficulty reaching orgasm with intercourse. A total of 42% of respondents felt that immunosuppressive medication was the main contributing factor to their sexual problems: 33% and 35% of respondents receiving tacrolimus or cyclosporine monotherapy, respectively, experienced some degree of sexual problems after transplantation. Despite the reported sexual problems, 59% of respondents were "moderately" to "very satisfied" with their sexual relationships after transplantation. Nineteen percent of the respondents used sildenafil to improve their sexual function, and 65% of these reported benefit. In conclusion, sexual problem after orthotopic liver transplantation is a common but poorly studied problem. Although this single-center study has shed some light on the relationship between liver transplantation and sexual health, further prospective studies, involving larger study population and validated instruments, will be needed to better evaluate the influence of liver transplantation on recipients' sexual health. During the past 20 years, orthotopic liver transplantation has emerged as the treatment of choice for endstage liver diseases of various causes. Most transplant centers reported 1-year survival rates for adult transplant recipients of about 80-90% and 9-year survival rates of 55%. 1 As the clinical outcomes of orthotopic liver transplantation continue to improve, resulting in fewer postoperative complications and better immunosuppression, other outcomes, such as health-related quality of life, become important targets of evaluation. Although considerable research has been conducted on the morbidity and mortality of orthotopic liver transplantation, less is known about the influence of orthotopic liver transplantation on health-related quality of life of the transplant recipients. In particular, literature on sexual health for this population is limited.Sexual health encompasses not only sexual function, but also involves the full range of human experience. Sexuality allows communication of emotional feelings, provides a means of physical pleasure and gratification, enhances feelings of self-worth, and strengthens relationships. 2...

Liver Transplant May Improve Erectile Function in Patients With Benign End-Stage Liver Disease: Single-Center Chinese Experience

“…Moreover, 84.1% of the responders had ED of different severities. The response rate was higher than those reported in previous studies by Ho and associates (42%) 17 and Hart and associates (39%). 18 The ability of the hypothalamic-pituitary-gonadal axis and sex steroid metabolism to resume physiological function after an LT has been demonstrated, 4 although it has been suggested that some transplant recipients may have persisting abnormalities, especially among those transplanted for alcohol-related cirrhosis.…”

“…Wang and associates 16 found the 57% of patients with alcohol-related cirrhosis and 59% of patients with HBV-related cirrhosis had ED. On the contrary, a recent cross-sectional study in 93 male LT recipients showed a relatively low sexual dysfunction rate of 24% before LT. 17 Our study demonstrated that men with BELD on a waiting list for an LT had a similar high prevalence of ED: 77.2% of patients responded to the survey, and only 47.7% of responders were sexually active; the IIEF-5 scores of the responders and sexually active patients were relatively low. Moreover, 84.1% of the responders had ED of different severities.…”

“…11,19,20 However, it is unclear whether sexual dysfunction relates to treatment with CNIs alone, or with the whole set of pharmacological therapies administered after an LT. 21 Sorrell and associates 3 reported that among men with ED before an LT, ED remained unchanged after an LT in 34.6%. In the study by Ho and associates, 17 twenty-four percent of responders reportedly had sexual dysfunction before LT, and this persisted in 15% after an LT. Moreover, 32% of the responders had a de novo sexual dysfunction after an LT, 23% had decreased libido, and 33% had difficulty in reaching orgasm with intercourse.…”

Erectile Dysfunction in Liver Transplant Patients

“…However, data concerning ED in male LT patients are, so far, limited. Most existing studies have used small samples, nonvalidated questionnaires, have concerned both genders (4)(5)(6), or have been published in the non-English literature (4).…”

Disease Targeted Measures of Health Related Quality of Life (HRQOL) in Patients with Advanced Liver Disease Before and After Liver Transplantation

“…Moreover we have to take into consideration the present available information on the natural history regarding the risks of "de novo" diseases, or malignancy or the primary disease recurrence in the long term (Telles-Correia, 2011;Estraviz, 2007). Other goals may be more widely accepted, for example, describing functional health and HRQOL before and after transplantation; comparing contrast outcomes and exploring whether physiological performance, demographics, and other clinical variables are predictors of posttransplantation QOL (Bravata& Keeffe, 2001;Ho, 2006;Aberg, 2009). …”