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Testicular Function, Semen Quality, and Fertility in Young Men After Renal Transplantation During Childhood or Adolescence

Background This study was conducted to assess reproductive endocrine function, testicular volume, semen quality, and fertility in adult male patients after renal transplantation (RTx) during childhood or adolescence. Methods Twenty-four RTx recipients (median age: 28.1 years) were examined at a median of 18.6 years after RTx. Reproductive hormone levels and semen samples were studied and compared to those of 56 age-matched controls (median age: 30.2 years). Eight RTx men (33%) had been treated with cyclophosphamide. Medical records were retrospectively reviewed and data on puberty, dialysis, and immunosuppressive medication were analyzed to evaluate the prospect of fertility and sexual health. Results The testicular volumes and total sperm counts of the RTx patients were smaller than those of the controls with a median of 11.4 versus 33.9 mL, P<0.001 and 1.3 versus 135.5 million, P<0.001, respectively. Only four (22%) of the RTx men had normospermia in semen sample. The reproductive hormone levels were normal in the majority of the RTx survivors, with only two survivors showing androgen deficiency. Patients without history of cyclophosphamide therapy had significantly smaller testes and total sperm counts (median: 12.5 mL and 16.3 million) in comparison with their healthy peers (P<0.001 in both), and those with previous cyclophosphamide treatment showed further worse outcome (8.5 mL and 0 million, respectively, P<0.001 in both). Conclusions Testicular function is often impaired even years after transplantation and poor semen quality decreases the prospect of fertility in men after pediatric RTx.