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Renal Transplantation Improves Erectile Function in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis.

PURPOSE
Erectile dysfunction (ED) has a lower prevalence in renal transplant recipients (RTRs) compared to dialysis patients. Despite this observation, the effect of renal transplantation (RT) on erectile function (EF) remains unknown. We aimed to assess the role of RT on EF and to determine potential factors improving or deteriorating ED.


MATERIALS AND METHODS
We conducted a systematic review and random-effects meta-analysis of observational studies comparing EF pre- and postoperatively in RTRs (PROSPERO ID: CRD42020189580). Records reporting relevant outcomes were identified through search of PubMed, Embase, Cochrane Library and Scopus databases from inception to September 2020. Judgement of the strength of evidence was performed with GRADE.


RESULTS
We included 20 studies with 1695 RTRs. At postoperative evaluation, the number of patients with ED reduced (RR: 1.21, 95%CI: 1.02-1.45, I2=88%). RTRs reported an improvement in EF (RR: 2.53, 95%CI: 1.44-4.44, I2=90%) and the mean international index of erectile function score increased by 3.04 points (95%CI: 0.63-5.45, I2=96%) after RT. These effects were not demonstrated in the sensitivity analysis. In individuals reporting severe ED, no favorable effect of RT was observed (RR: 1.51, 95%CI: 0.85-2.68, I2=33%). For all outcomes, the strength of evidence was considered low or very low due to methodological concerns and high heterogeneity among the included studies.


CONCLUSIONS
RT improves EF and the risk of ED reduces postoperatively compared to preoperatively. However, evidence on the matter is mostly based on low-quality data. More studies with standardized outcomes are needed to validate and strengthen our findings.