Female Sexual Function and Depression After Kidney Transplantation: Comparison Between Deceased- and Living-Donor Recipients J.F. Cabrala,*, V. Cavadasa, M. Silva Ramosa, A. Fragaa, M. La Salete Martinsb, A. Rochab, J. Vidinhac, and F. Brancoa a Department of Urology, Hospital de Santo António, C.H.P, Portugal; bDepartment of Nephrology, Hospital de Santo António, C.H.P, Portugal; and cDepartment of Nephrology, Hospital de S. Teotónio, CHTV, Portugal
ABSTRACT Disturbances in sexual function and depression are a common feature in women with chronic renal failure. Living-donor kidney transplantation seems to warrant better results than its cadaveric counterpart in many aspects but its impact on post-transplantation sexual function remains unknown. This study aimed to compare post-transplantation sexual function and depression in women receiving kidney grafts from living and deceased donors. From a single-center prospective database of 2016 renal transplantations between June 2011 and June 2013, we enrolled 50 sexually active women after kidney transplantation. Female sexual function was evaluated with the Female Sexual Function Index Questionnaire (FSFI) and depression was assessed using the Beck Depression InventoryeII (BDI-II) scale. Thirty-four patients referred the questionnaires. The sexual domains of satisfaction and desire were significantly better in living-donor receptors; in all other domains evaluated by FSFI no statistically significant difference was encountered between groups, although living-donor receptors tended to report better function. Total BDI-II was well correlated with total FSFI score in our study cohort (Spearman’s rho ¼ 0.80, P < .001). Only 34.6% of women referred to have discussed sexual issues with their physicians before transplantation, whereas 73.1% stated it would have been important. In conclusion, livingdonor transplantation exerted a positive effect on women’s sexual function.
D
ISTURBANCES in sexual function are a common feature in patients with chronic renal failure, affecting 90% of patients before initiating dialysis and 60% to 70% of those on dialysis [1,2]. Hormonal abnormalities, peripheral neuropathy, vascular disease, and medications are important contributors [3]. Psychological and emotional distresses are also important and do not always receive appropriate attention [4]. Kidney transplantation seems to warrant a better sexual function than replacement therapies [5,6]. The regularization hypothalamic-pituitary-gonadal axis with normalization of prolactin levels is a plausible explanation as studies show the involvement of hyperprolactinemia on depression, loss of libido, and menstrual abnormalities [5]. Living-donor transplantation, more than obviating the problem of scarcity of organs, enables better results compared to its cadaveric-donor counterpart in many important aspects, but sexual function remains a poorly studied subject in both male and female patients. ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
Transplantation Proceedings, 47, 989e991 (2015)
MATERIAL AND METHODS From a single-center prospective database of 2016 renal transplants, we enrolled, after the approval of Centro Hospitalar do Porto Ethics Committee, 50 female transplanted patients. The study was conducted between June 2011 and June 2013. Inclusion criteria were sexually active women, ages between 20 and 65 years, with well-functioning graft; exclusion criteria were history of graft rejection or sexual inactivity. Patients were informed about the content of the study at the outpatient consultation. Those who agreed to participate signed the consent and received the questionnaires. Fifty patients were included initially, 34 referred the questionnaires. Epidemiological and clinical data were collected. Female sexual function was evaluated with the Female Sexual Function Index Questionnaire (FSFI), and depressive symptoms were assessed *Address correspondence to João Ferreira Cabral, MD, Department of Urology, Hospital de Santo António, C.H.P, 4050-001, Porto, Portugal. E-mail: joaoferreiracabral@gmail. com 0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2015.03.036
989
990
CABRAL, CAVADAS, SILVA RAMOS ET AL Table 1. Epidemiological and Clinical Data
Number of patients Age (y) ESRD (mo) Follow-up after Transplantation (mo) GFR (mL/min) BMI (kg/m2)
Cesarean/delivery labor Diabetes Hypertension Menopause Tobacco use Beta-blockers ACEI Calcium channel blockers Antidepressive ARA Prednisolone Cyclosporine Tacrolimus Micophenolate mofetil Sirolimus
Living Donor
Cadaveric Donor
P Value (Mann-Whitney)
17 38.5 30.5 62
17 51.5 44.5 84.5
ABSTRACT Disturbances in sexual function and depression are a common feature in women with chronic renal failure. Living-donor kidney transplantation seems to warrant better results than its cadaveric counterpart in many aspects but its impact on post-transplantation sexual function remains unknown. This study aimed to compare post-transplantation sexual function and depression in women receiving kidney grafts from living and deceased donors. From a single-center prospective database of 2016 renal transplantations between June 2011 and June 2013, we enrolled 50 sexually active women after kidney transplantation. Female sexual function was evaluated with the Female Sexual Function Index Questionnaire (FSFI) and depression was assessed using the Beck Depression InventoryeII (BDI-II) scale. Thirty-four patients referred the questionnaires. The sexual domains of satisfaction and desire were significantly better in living-donor receptors; in all other domains evaluated by FSFI no statistically significant difference was encountered between groups, although living-donor receptors tended to report better function. Total BDI-II was well correlated with total FSFI score in our study cohort (Spearman’s rho ¼ 0.80, P < .001). Only 34.6% of women referred to have discussed sexual issues with their physicians before transplantation, whereas 73.1% stated it would have been important. In conclusion, livingdonor transplantation exerted a positive effect on women’s sexual function.
D
ISTURBANCES in sexual function are a common feature in patients with chronic renal failure, affecting 90% of patients before initiating dialysis and 60% to 70% of those on dialysis [1,2]. Hormonal abnormalities, peripheral neuropathy, vascular disease, and medications are important contributors [3]. Psychological and emotional distresses are also important and do not always receive appropriate attention [4]. Kidney transplantation seems to warrant a better sexual function than replacement therapies [5,6]. The regularization hypothalamic-pituitary-gonadal axis with normalization of prolactin levels is a plausible explanation as studies show the involvement of hyperprolactinemia on depression, loss of libido, and menstrual abnormalities [5]. Living-donor transplantation, more than obviating the problem of scarcity of organs, enables better results compared to its cadaveric-donor counterpart in many important aspects, but sexual function remains a poorly studied subject in both male and female patients. ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
Transplantation Proceedings, 47, 989e991 (2015)
MATERIAL AND METHODS From a single-center prospective database of 2016 renal transplants, we enrolled, after the approval of Centro Hospitalar do Porto Ethics Committee, 50 female transplanted patients. The study was conducted between June 2011 and June 2013. Inclusion criteria were sexually active women, ages between 20 and 65 years, with well-functioning graft; exclusion criteria were history of graft rejection or sexual inactivity. Patients were informed about the content of the study at the outpatient consultation. Those who agreed to participate signed the consent and received the questionnaires. Fifty patients were included initially, 34 referred the questionnaires. Epidemiological and clinical data were collected. Female sexual function was evaluated with the Female Sexual Function Index Questionnaire (FSFI), and depressive symptoms were assessed *Address correspondence to João Ferreira Cabral, MD, Department of Urology, Hospital de Santo António, C.H.P, 4050-001, Porto, Portugal. E-mail: joaoferreiracabral@gmail. com 0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2015.03.036
989
990
CABRAL, CAVADAS, SILVA RAMOS ET AL Table 1. Epidemiological and Clinical Data
Number of patients Age (y) ESRD (mo) Follow-up after Transplantation (mo) GFR (mL/min) BMI (kg/m2)
Cesarean/delivery labor Diabetes Hypertension Menopause Tobacco use Beta-blockers ACEI Calcium channel blockers Antidepressive ARA Prednisolone Cyclosporine Tacrolimus Micophenolate mofetil Sirolimus
Living Donor
Cadaveric Donor
P Value (Mann-Whitney)
17 38.5 30.5 62
17 51.5 44.5 84.5
