Sexuality, fertility and pregnancy after kidney transplantation

Aims. - To describe sexuality and fertility alterations secondary to chronic kidney disease and their outcomes after renal transplantation. Material and methods. - An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlimnih.gov) and Embase (http://www.embase.com) using different associations of the following keywords: erectile dysfunction; impotence; sexuality; pregnancy; fertility; renal transplantation. Publications obtained were selected based on methodology, language, date of publication (last 10 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 706 articles. After reading titles and abstracts, 76 were included in the text, based on their relevance. Results. - The observed prevalence of erectile dysfunction is high in men with chronic kidney disease. The causes of erectile dysfunction are numbers and its origin is often multifactorial. Most of the time, kidney transplantation improves sexuality and the management of erectile dysfunction in transplanted men is similar to the general population. Improvement in sexuality in men and women after kidney transplantation may conduct to pregnancy. The outcomes of pregnancy after transplantation are quite good in absence of risk factors such as time to pregnancy less than 1 year after transplantation, uncontrolled high blood pressure, and decreased renal function of the graft. Adaptation of immunosuppression may be required to avoid any teratogenicity for the fetus. Conclusion. - Kidney transplantation improves sexuality and fertility in men and women with chronic kidney disease. (C) 2016 Elsevier Masson SAS. All rights reserved.