| Chronic renal failure (CRF) is caused by a variety of causes kidney damage and results of progressive deterioration. it is a threat to human health, with natural population incidence rate (50-200)/100people in recent years, an average of about increase rate of8%per year. Chronic renal failure or uremia in severe condition is not an independent disease. A variety of reasons cause kidney damage and progressive deterioration. A series of complex symptom will appear when renal function decreased to about10%of normal. Etiological mechanisms of CRF are yet unclear. Currently, hypothesis about CRF mainly on glomerular perfusion, high-pressure, high filtration; glomerular capsule pressure, high metabolism of renal tubular and compensatory hypertrophy, glomerular and interstitial changes:renal glomerular cells, tubular cells and infiltrating cells produce a large number of cytokines which involve in the process of renal function deterioration.The hypothalamic-pituitary-gonadal axis dysfunction is widespread among patients with chronic renal failure (CRF). Sexual dysfunction is a common clinical manifestation of CRF male and female patients. The risk of female sexual dysfunction in patients with chronic renal failure is higher than in healthy women. Abnormal menstrual cycle and sexual dysfunction, such as loss of libido, lack of orgasm, especially amenorrhea occurs in the majority of long-term dialysis treatment of adult female patients. Abnormal menstrual cycle concerned with sexual dysfunction, such as loss of libido, lack of orgasm, especially amenorrhea which occurs in the majority of long-term dialysis treatment of adult female patients. Female patients with chronic renal failure often suffer some symptoms such as loss of libido, difficulty to reach orgasm. Sexual quality of life of female uremic patients is susceptible to the impact of hemodialysis, which expressed as reduction of frequency of sex, loss of libido and sexual dysfunction.Chronic renal failure is considered to be one of important risk factors for erectile dysfunction. Erectile dysfunction after renal transplantation is an important factor affecting patients’quality of life after kidney transplantation. Erectile dysfunction seriously affects the quality of life of patients, causes anxiety, loss of self-confidence, lack of imagination, depression, lack of interpersonal relationships, loss of self-esteem and other psychological disorder.Since the first successful kidney transplantation between identical twins was conducted by Pro. Murry in1954, the renal transplantation has been widely used all over the world. And scholars of basic and clinical researches have overcome numerous difficulties in terms of immunology, surgical techniques and ethnics, which pave the way for the development of renal transplantation. With the transformation of the modern biomedical model to biological-psychological-social model, the quality of life becomes a new health indicator in patients after renal transplantation. For kidney transplant patients, transplant surgery is only the first step. The transplanted kidney survival is important, however, the patient’s quality of life and physical and mental health is more important. Survival rates and quality of life of renal transplant recipients in recent years has been significantly improved, and postoperative complications decreased. So, other assessment objective is even more important. Sexual function is an important part of the quality of life of patients after renal transplantation; the patient’s sexual function problems have become important factors that affect the quality of life, but study about this part is rather limited. Chapter1Investigation of sexual function in premenopausal women before and after renal transplantationObjective To study sexual function in adult premenopausal women before and after renal transplantation.Methods1.From2009to2011,in our hospital female recipients received kidney transplantation, normal sexual life before the illness and renal function returned to normal after surgery. Inclusion criteria:married women,25to45years old, not menopause, dialysis treatment over six months, normal renal function (serum creatinine44-133μmol/L, GFR>90ml/min) over six months after transplantation. Exclusion criteria:uterine and/or ovarian resection history, previous history of hyperprolactinemia, pituitary disease, overactive bladder, mental disorders were excluded. A total of42women were enrolled in the study.All women underwent a hormonal profile determination, calculated menstrual cycles, and filled out the Female Sexual Function Index (FSFI) administered before and6months after transplantation.2. Statistical Analysis:All data used SPSS13.0statistical analysis software. Measurement data are expressed as mean±standard deviation (x±s). Differences among the paired measurement data were analyzed by paired t-test. P<0.05was considered statistically significant.Results1. Before kidney transplantation the cases of amenorrhea, Oligomenorrhea, polimenorrhea, and eumenorrhea were18cases (42.9%),10cases (23.8%),5cases (11.9%) and9cases (21.4%) respectively. After transplantation the cases were7cases (16.7%),5cases (11.9%),6cases (14.3%) and24cases (57.1%) respectively.2. After renal transplantation prolactin (PRL), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) significantly decreased. The level of PRL, FSH, and LH before transplantation was89.99±27.96ng/ml,34.75±19.26mIU/ml,39.65±17.87mIU/ml. After renal transplantation the level of PRL, FSH and LH dropped to39.52±26.06ng/ml,11.51±6.0mIU/ml,6.99±4.67mIU/ml.The differences among two groups were significant (P<0.001). Estradiol (E2) and progesterone (P) increased compared with the preoperative (P<0.001). The level of E2, P before transplantation was90.01±37.91mIU/ml,20.28±13.83ng/ml. After renal transplantation the level of E2and P increased to166.48±62.39mIU/ml,42.51±18.73ng/ml.The differences among two groups were significant (P<0.001).3. Nineteen patients (45.2%),36patients(85.7%) before and after surgery respectively acknowledged having an active sexual life. The total incidence of Female Sexual dysfunction (FSD) before and after kidney transplant were90.5%,40.5%(P <0.001).The scores of desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were significantly lower than scores after kidney transplant(P<0.001). The scores of desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were2.68±1.27,2.43±1.26,2.05±1.39,3.0±1.64,3.15±1.45,3.46±1.24respectively. The scores in the six areas above in the post-transplant increased to4.16±1.23,4.49±1.10,4.28±1.21,4.42±1.12,4.38±1.18,4.52±1.22, respectively. The differences of the scores in the six areas between before and after transplantation were significant (P<0.001).4.15patients were diagnosed with heart disease sexual dysfunction before renal transplantation. Their scores of desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were significantly increased after kidney transplant. The scores of desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were2.49±1.34,2.08±1.27,1.77±1.10,2.68±1.28,2.53±1.05,2.36±1.56, respectively. The scores in the six areas above in the post-transplant increased to4.18±1.32,4.33±1.30,4.17±1.39,4.63±0.93,4.31±1.52,4.69±0.98. The differences of the scores in the six areas between before and after transplantation were significant (P<0.001)Conclusions A successful transplantation should significantly improve sexual function in premenopausal women, significant improvement in sex hormone levels after transplantation. Chapter2Investigation of sexual function in male kidney transplant recipientsObjective To investigate and evaluate sexual function in male kidney transplant recipientsMethod1、A total of60patients were enrolled in the study,who received a kidney transplant at our hospital between1998-2010. The patients have normal sex activities before illness and have good renal graft function after transplant. Questionnaires used to investigate the first spermatorrhea, sexual ability, sexual frequency and satisfaction rate of all60cases after surgery. Were collected during dialysis and after3months, underwent routine checks of recipients of semen, sperm motility, survival and deformity index as the observed indicators.30healthy adult males as a control group, compared sperm motility, survival, deformity index, the ability of sex life and sexual satisfaction rate indicators before and after transplantation.2、Statistical Analysis:All data used SPSS13.0statistical analysis software. Measurement data are expressed as mean±standard deviation (x±s). Differences among groups were analyzed by One-way ANOVA. LSD (Least Significant Difference) method should be used in the case of homogeneity of variance; otherwise Dunnett’s T3methods should be used in the case of variance nonhomogeneity. Differences among the paired measurement data were analyzed by paired t-test.Chi-square was used to compare the rates between two groups.P<0.05was considered statistically significant.Result Following the graft function gradually regained.54patients had spermatorrhea in the30-92days after transplantation, and other six cases did not have spermatorrhea because of sexual life.The sperm motility, survival and deformity index in patients before transplant were significantly lower than the healthy control group, the differences among two groups were significant (P<0.001). The above parameters were significantly improved after transplantation, the differences between groups before and after transplantation were also significant (.P<0.001).The differences of sperm motility, survival between patients before transplant and the healthy control group were not significant (P=0.195、P=0.798). The sperm deformity index in patients after transplant were significantly lower than the healthy control group, the differences among two groups were significant (P=0.002).All60cases have normal sex activist before CRF. The frequency of sexual life is2to9times/month in49cases (81.7%) before transplantation, and sexual satisfaction rate is96.7%(58/60). Before transplant,50patients (83.3%) did not have sex activity, only10patients underwent sexual life and sexual satisfaction rate was5%(3/60).Postoperative56male patients began to have sex in2-4months with86.7%rate of satisfaction (52/60), except the other4refusing to have sex because worries about graft damage by sex activities. The proportion of recipients after postoperative sexual life skills, sexual frequency and sexual satisfaction were significantly improved. The differences between groups before and after transplantation were also significant (P<0.05),but the differences between control group and post-transplantation group were not significant (P>0.05). After transplantation,the proportion of recipients with active sex life increased, the frequency of sex life and sexual satisfaction rate significantly improved. After transplantation sexual satisfaction rate of patients was significantly higher than the pre-transplant, the differences were significant (P<0.001). The sexual satisfaction rate in the post-transplant group was slight decline compared to those with the control group.Conclusion After graft function after renal transplantation is back to normal, and the recipient’s sex life capability can be obtained improved significantly, most of the recipients can be restored close to the level before the illness.Sperm motility, survivaland Sperm deformity Index improved markedly compared with pre-transplant Chapter3Pregnancy outcomes in female kidney transplant recipients and follow up for the health of the offspringObjective To evaluate the pregnancy outcomes in female kidney transplant recipients and the long-term follow up for the health of the offspring.Methods Clinic data from15female renal transplant recipients with pregnant duration more than5months from April1978to April2011and their offspring were retrospectively analyzed.Results1.15recipients were taking CsA or Tac based immunosuppressive regimens.12had successful pregnancies with stable and functioning grafts;1died of pulmonary infection and cardiac failure with functioning graft after the delivery of a healthy male infant;2underwent chronic rejection proven by biopsy at week21and23respectively, pregnancy were therefore terminated and the grafts were lost even after rescue. All13newborns were smoothly delivered by cesarean section, they had an average gestational age of39.5±1.3weeks, and a mean birth weight of2.58±1.44kg, Apgar scale for each infant was10, respectively。There were no birth defects, structural malformations, nor learning disabilities in13newborns, and their mothers all chose to bottle-feed.13children had similar intelligent, physical and mental development as the same generation.7children experienced repeated respiratory tract infection during0-2years, and1was diagnosed with attention deficit hyperactivity disorder. The oldest offspring is21years old and the youngest is3years old by far.2. In accordance with the recipient taking immunosuppressive agents are divided into CsA group and Tac group. After transplantation, women of CsA group and Tac group got pregnant at29.5±3.2year-old and29.0±3.9year-old, the difference was not statistically significant (t=0.253, P=0.805). The time of transplantation to conceive in this two groups were64.4±12.6months and41.2±17.9months, the difference was not statistically significant(t=2.756, P=0.19). The differences of neonatal gestational age, weight, and length differences were not statistically significant (t=0.710,P=0.492; t=-0.659, P=0.524; t=0.258, P=0.801). Conclusions Female renal kidney recipients could achieve successful pregnancies and deliveries post transplantation with strict criteria. Rigorous assessment and follow-up should be taken during periconceptional and postnatal in case of health of offspring, renal graft and recipients. |
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