Background/Aims: Male patients with end-stage renal disease suffer from sexual disturbances and infertility. Disturbances in the hypothalamic-pituitary-gonadal axis are one of the causes of this. Decreased testosterone synthesis in Leydig cells of the testes and hyperprolactinemia are common. Kidney transplantation, unlike hemodialysis, normalizes these changes. However, how kidney transplantation affects Sertoli cell function is poorly understood. This study is aimed at investigating the changes in fertility-related hormones in men before, during, and after renal transplantation. Methods: This longitudinal and prospective single center study enrolled 12 men undergoing living donor kidney transplantation. Plasma levels of creatinine, cystatin C, and serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, sex hormone-binding globulin, inhibin B, and anti-Müllerian hormone (AMH) were assayed at 10 different time points before, during, and after kidney transplantation. Results: A rapid decrease in creatinine and cystatin C levels indicated successful renal transplantation. High pre-transplantation plasma levels of prolactin (mean 516 ± 306 mIE/L) and LH (9.4 ± 4.7 IU/L) were normalized after 7 days (248 ± 161 mIE/L and 6.1 ± 3.1 IU/L, respectively). Testosterone decreased rapidly during transplantation and increased again one week post-transplantation. Sertoli cell-derived hormone inhibin B decreased after transplantation, and there was a small non-significant trend of increased AMH after 12 months. Conclusion: Sertoli cell function, based on AMH and inhibin B levels, does not improve to the same extent or as fast as Leydig cell function after kidney transplantation, as determined by testosterone and LH levels.

Keywords:
Transplantation, Hemodialysis, Fertility, Chronic kidney disease
1.
Palmer BF: Sexual dysfunction in uremia. J Am Soc Nephrol 1999; 10: 1381–1388.
2.
Akbari F, Alavi M, Esteghamati A, Mehrsai A, Djaladat H, Zohrevand R, Pourmand G: Effect of renal transplantation on sperm quality and sex hormone levels. BJU Int 2003; 92: 281–283.
3.
Eckersten D, Giwercman A, Christensson A: Male patients with terminal renal failure -exhibit low serum levels of anti-müllerian hormone. Asian J Androl 2015; 17: 149–153.
4.
Eckersten D, Tsatsanis C, Giwercman A, Bruun L, Pihlsgård M, Christensson A: MicroRNA-155 and anti-Müllerian hormone: new potential markers of subfertility in men with chronic kidney disease. Nephron Extra 2017; 7: 33–41.
5.
Lessan-Pezeshki M, Ghazizadeh S: Sexual and reproductive function in end-stage renal disease and effect of kidney transplantation. Asian J Androl 2008; 10: 441–446.
6.
Xu LG, Xu HM, Zhu XF, Jin LM, Xu B, Wu Y, Lu NQ: Examination of the semen quality of patients with uraemia and renal transplant recipients in comparison with a control group. Andrologia 2009; 41: 235–240.
7.
Procci WR, Goldstein DA, Adelstein J, Massry SG: Sexual dysfunction in the male patient with uremia: a reappraisal. Kidney Int 1981; 19: 317–323.
8.
Chopp RT, Mendez R: Sexual function and hormonal abnormalities in uremic men on chronic dialysis and after renal transplantation. Fertil Steril 1978; 29: 661–666.
9.
Jost A: Comment se différencie le sexe de l'embryon. Atomes 1947; 2: 368–372.
10.
Hamdi SM, Walschaerts M, Bujan L, Rostaing L, Kamar N: A prospective study in male recipients of kidney transplantation reveals divergent patterns for inhibin B and testosterone secretions. Basic Clin Androl 2014; 24: 11.
11.
Anawalt BD, Bebb RA, Matsumoto AM, Groome NP, Illingworth PJ, McNeilly AS, Bremner WJ: Serum inhibin B levels reflect Sertoli cell function in normal men and men with testicular dysfunction. J Clin Endocrinol Metab 1996; 81: 3341–3345.
12.
Huyghe E, Zairi A, Nohra J, Kamar N, Plante P, Rostaing L: Gonadal impact of target of rapamycin inhibitors (sirolimus and everolimus) in male patients: an overview. Transpl Int 2007; 20: 305–311.
13.
Zachoval R, Jarabak J, Slatinska J, Burgelova M, Sobotka V, Vranova J, Krhut J: Dynamics of fertility in patients on waiting list for kidney transplantation. Bratisl Lek Listy 2013; 114: 711–715.
14.
Handelsman DJ, Dong Q: Hypothalamo-pituitary gonadal axis in chronic renal failure. Endocrinol Metab Clin North Am 1993; 22: 145–161.
15.
Haberman J, Karwa G, Greenstein SM, Soberman R, Glicklich D, Tellis V, Melman A: Male fertility in cyclosporine-treated renal transplant patients. J Urol 1991; 145: 294–296.
16.
De Celis R, Pedrón-Nuevo N: Male fertility of kidney transplant patients with one to ten years of evolution using a conventional immunosuppressive regimen. Arch Androl 1999; 42: 9–20.
17.
Aulakh BS, Singh SK, Khanna S, Kaura R, Goyal S: Impact of renal transplantation on gonadal function in male uremic patients-our experience. Transplant Proc 2003; 35: 316.
18.
Zeyneloglu HB, Oktem M, Durak T: Male infertility after renal transplantation: achievement of pregnancy after intracytoplasmic sperm injection. Transplant Proc 2005; 37: 3081–3084.
19.
Pertuz W, Castaneda DA, Rincon O, Lozano E: Sexual dysfunction in patients with chronic renal disease: does it improve with renal transplantation? Transplant Proc 2014; 46: 3021–3026.
20.
Leroy C, Rigot JM, Leroy M, Decanter C, Le Mapihan K, Parent AS, Le Guillou AC, Yakoub-Agha I, Dharancy S, Noel C, Vantyghem MC: Immunosuppressive drugs and fertility. Orphanet J Rare Dis 2015; 10: 136.
21.
Morken NH, Diaz-Garcia C, Reisaeter AV, Foss A, Leivestad T, Geiran O, Hervás D, Brännström M: Obstetric and neonatal outcome of pregnancies fathered by males on immunosuppression after solid organ transplantation. Am J Transplant 2015; 15: 1666–1673.
22.
Cao ZG, Liu JH, Zhu YP, Zhou SW, Qi L, Dong XC, Wu B, Lin ZB: [Effects of different immunodepressants on the sperm parameters of kidney transplant recipients]. Zhonghua Nan Ke Xue 2006; 12: 405–407.
23.
Georgiou GK, Dounousi E, Harissis HV: Calcineurin inhibitors and male fertility after renal transplantation – a review. Andrologia 2016; 48: 483–490.
24.
Caneguim BH, Cerri PS, Spolidório LC, Miraglia SM, Sasso-Cerri E: Structural alterations in the seminiferous tubules of rats treated with immunosuppressor tacrolimus. Reprod Biol Endocrinol 2009; 7: 19.
© 2017 S. Karger AG, Basel
2017
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