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From the * Center for Renal Transplantation,
Jiulisong Hospital, Hangzhou, Zhejiang, China; the
Institute of Urology, Transplantation Center,
the Second Hospital of Shandong University, Jinan, Shandong, China; the
Department of Urology, the 153rd Hospital,
Zhengzhou, Henan, China; and the Zhejiang Family
Planning Research Institute, Hangzhou, Zhejiang, China.
| Correspondence to: Prof Long-Gen Xu, Director, Center for Renal Transplantation, Jiulisong Hospital, Hangzhou, Zhejiang 310013, China (e-mail: xulonggen{at}sina.com). |
| Received for publication August 24, 2007; accepted for publication May 22, 2008. |
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Abstract |
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Key words: Questionnaire, hemodialysis, immunosuppressive drug therapy
Because up to 40% of men receiving a kidney transplant are younger than 50, the fertility of male renal transplant recipients is a major concern (Huyghe et al, 2007). Several studies have suggested that most patients subjected to kidney transplantation and conventional immunosuppressants experience adequate recovery of sexual and reproductive function (Baumgarten et al, 1977; Holdsworth et al, 1978; Rodrigues Netto et al, 1980; Eid et al, 1996; De Celis and Pedrón-Nuevo, 1999). In fact, the levels of sex hormones and the quality of sexual life in patients with uremia were significantly improved after renal transplantation (Zheng et al, 1995; Prem et al, 1996). Also, the semen quality of patients with uremia improved after renal transplantation (Xu et al, 2004, 2005).
This retrospective study surveys the marital status and fertility of 243 male renal transplant recipients of reproductive age who were single before renal transplantation. These patients were identified from 2007 patients who underwent renal transplantation between April 1988 and April 2006 at 3 renal transplantation centers in the authors' hospitals in China.
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Materials and Methods |
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Methods
Male recipients of renal transplants who were single and of reproductive
age before surgery were selected from the original case records of renal
transplantations in the authors' hospitals. A questionnaire was designed to
survey the renal transplant recipients regarding their marital status, their
fertility, and the developmental conditions of their offspring fathered after
the transplantation. The survey covered the recipient's age, vocation,
culture, marital status, course of renal disease, and dialysis method; the
time of renal transplantation; the use of immunosuppressants after renal
transplantation; the pregnancy status of the patient's wife; and the
offspring's developmental conditions. Follow-up was conducted with those
recipients who completed the questionnaire in the clinic or by telephone.
Statistical Analysis
Individual groups were compared with Student's t test, and the
data were analyzed using SPSS 11.0 statistical software (SPSS Inc, Chicago,
Illinois). Results are expressed as mean ± SEM, and a value of
P < .05 was considered significant.
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Results |
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The types and dosages of immunosuppressants taken by the recipients when their offspring were conceived were as follows: cyclosporin A (CsA), 1.5–3.5 mg kg–1 d–1; tacrolimus (FK 506), 0.03–0.1 mg kg–1 d–1; azathioprine (Aza), 50 mg/d; prednisone (Pred), 5–10 mg/d; and mycophenolic acid (MMF), 1.0 g/d. As a group, the recipients took a variety of combined immunosuppressive therapies, including 55 patients who took CsA-Aza-Pred, 9 who took CsA-MMF-Pred, 4 who took FK506-MMF-Pred, and 1 who took Aza-Pred.
Fifty-three of 62 (85.5%) patients who wished to have children had done so. Seven patients were using contraception. Nine of 69 patients did not father any children, with 3 of these cases because the subjects' wives suffered from uterine myomata and appendicitis. One patient's wife, who had a uterine myoma that was 2.8 x 2.6 cm in size, had been treated with leuporelin. After 3 months, the fibroid was found to be 2.6 x 2.0 cm in size. In the case of another patient's wife, a fibroidectomy had been performed 6 months earlier. Neither of the 2 women had become pregnant by the time of follow-up. In addition, 1 case of appendicitis was treated with antibiotics.
Moreover, the examination of semen samples obtained from 4 of 6 patients who had tried unsuccessfully to father children showed normal results according to the World Health Organization manual (1999), and the reasons for their inability to father children remain unidentified. Therefore, the incidence of infertility in these recipients was similar to that of a group of men with normal renal function. In addition, 7 patients were using contraception; among them, 4 did not yet desire to have children, and 3 had no desire to father children.
Sixty-nine of 185 (37.3%) renal transplant recipients got married 12–88 months (mean, 32.9 ± 14.38) after transplantation; among these married patients, 53 fathered 54 children 9–72 months (mean, 25.81 ± 15.33) after marriage. (One patient had twins.) Thus, the interval between transplantation and pregnancy was estimated to be 23–120 months (mean, 44.59 ± 17.32 months). Of the 54 newborn children, 26 were boys and 28 were girls. The birth weights of the newborns ranged from 2500 to 4600 g (mean, 3395 ± 456.80 g). In April 2006, the children were 2–211 months old (mean, 50.69 ± 48.41 months) and had developed normally.
The function of the allografted kidneys of the recipients was good at the time of conception. Three of 69 patients suffered from chronic graft rejection and resumed hemodialysis 2–11 years after having children. In addition, 1 patient died of dysfunction of the transplanted kidney when immunosuppressive drug therapy was discontinued 9 years after he had fathered a child. Another patient died in an accident 1 year after fathering a baby. All other recipients were still alive and in good health at the time of the survey.
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Discussion |
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Marital Status in Male Renal Transplant Recipients
Marital status has an important influence on people's mental health and on
the stabilization and development of society
(Guo and Hu, 2004). All of the
243 recipients who completed the questionnaire in our survey were of
reproductive age, but they did suffer from uremia, which could lead to the
impairment of many organs and tissues. Thus, their physical capacity,
nutritional state, social communication, responsibility, routine work, family
life, physiological health, and quality of life were seriously reduced. While
suffering from uremia, the patients usually did not want to court. As
indicated in this study, uremia had led to divorce for 7 patients, suggesting
that uremia in a man can seriously affect his marriage. In general, after
successful renal transplantation, the toxin in uremia patients can be removed
by a transplanted kidney, leading to recovery of normal endocrine function,
correction of the metabolic disorder, and an improvement in the quality of
life up to the level of healthy men. In our investigation, 69 of 189 cases
were married 12–88 months (mean, 32.19 ± 14.38 months) after
renal transplantation. Moreover, 2 of the 7 patients divorced because of
uremia remarried, one 2 and one 5 years after transplantation.
Research suggests that it is safe for men with transplants to have children. Armenti et al (2004) reported 97 cases of male recipients who received immunosuppressants such as CsA, FK506, or MMF, and had fathered children 120 times, leading to a total of 126 children, including twins and triplets. The mean birth weight of newborns was 3244 ± 649 g, which is very similar to the mean for babies in the general population, and no pediatric abnormalities were observed. In our study, 53 recipients fathered 54 children. The birth weight of newborns ranged from 2500 to 4600 g (3395 ± 456.80), which was similar to data reported in the literature. Physical examination showed that all children developed normally and revealed no abnormalities. Also, the function of the transplanted kidneys of the 53 patients was normal at the time of conception. Three patients, however, suffered from chronic graft rejection and resumed hemodialysis 2–11 years after fathering children. Unfortunately, 2 patients died, one from dysfunction of the transplanted kidney and another in an accident. It was clear that the ability of these 3 patients to father children was unaffected by the hemodialysis therapy and the later death of 2 patients. Therefore, it is safe to conclude that the renal transplantation had no observable negative effects on the health or fertility of the male recipients, on the functioning of the transplanted kidney, or on the health of the children fathered after the procedure. The renal transplant recipients were able to produce healthy children. Unfortunately, it was difficult for us to follow up on all patients who have received a renal transplant in our hospitals over the years that these procedures have been offered. Therefore, we are unable to calculate the percentage of transplant recipients who can have children.
To our knowledge, this is the largest study involving follow-up on renal transplant recipients that has been conducted so far in China. The results we gained in this study on marriage status and fertility of the male recipients of renal transplant will provide some important reference information for male renal transplant recipients concerning marriage and birth control. Because kidney transplantation greatly improves fertility in men affected by renal disease, those couples who do not wish to have children should use an effective method of contraception. Finally, it is very important to indicate that in addition to needing contraception if they do not conceive, male renal transplant recipients should expect fertility rates that are similar to those of the general population.
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Acknowledgments |
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References |
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