• alcohol
• cirrhosis
• depression
• liver transplantation
• portal hypertension

• Humans
• Sexual Health
• Liver Transplantation
• Sexual Dysfunction, Physiological/etiology
• Sexual Dysfunction, Physiological/therapy
• Sexual Dysfunction, Physiological/physiopathology
• Sexual Dysfunction, Physiological/epidemiology
• Female
• Male
• Liver Cirrhosis/complications
• Liver Cirrhosis/physiopathology
• Liver Cirrhosis/surgery
• Liver Diseases/complications

• donor
• immunosuppression
• liver transplantation
• recipient
• recurrence
• transplant oncology

• Liver Transplantation/methods
• Liver Transplantation/standards
• Humans
• End Stage Liver Disease/surgery

Infections, including common communicable infections such as influenza, frequently cause disease after organ transplantation, although the quantitative extent of infection and disease remains uncertain.

A cohort study was conducted to define the burden of notifiable infectious diseases among all solid organ recipients transplanted in New South Wales, Australia, 2000–2015. Data linkage was used to connect transplant registers to hospital admissions, notifiable diseases, and the death register. Standardized incidence ratios (SIRs) were calculated relative to general population notification rates, accounting for age, sex, and calendar year. Infection-related hospitalizations and deaths were identified.

Among 4858 solid organ recipients followed for 39 183 person-years (PY), there were 792 notifications. Influenza was the most common infection (532 cases; incidence, 1358 [95% CI, 1247–1478] per 100 000 PY), highest within 3 months posttransplant. Next most common was salmonellosis (46 cases; incidence, 117 [95% CI, 87–156] per 100 000 PY), then pertussis (38 cases; incidence, 97 [95% CI, 71–133] per 100 000 PY). Influenza and invasive pneumococcal disease (IPD) showed significant excess cases compared with the general population (influenza SIR, 8.5 [95% CI, 7.8–9.2]; IPD SIR, 9.8 [95% CI, 6.9–13.9]), with high hospitalization rates (47% influenza cases, 68% IPD cases) and some mortality (4 influenza and 1 IPD deaths). By 10 years posttransplant, cumulative incidence of any vaccine-preventable disease was 12%, generally similar by transplanted organ, except higher among lung recipients. Gastrointestinal diseases, tuberculosis, and legionellosis had excess cases among transplant recipients, although there were few sexually transmitted infections and vector-borne diseases.

There is potential to avoid preventable infections among transplant recipients with improved vaccination programs, health education, and pretransplant donor and recipient screening.

• Immunosuppression
• Infertility
• Liver transplantation
• Pregnancy outcomes

Sexual dysfunction is defined as any abnormality in sexual arousal, libido, intercourse, orgasm, or satisfaction. It is prevalent in patients with chronic and end-stage kidney disease, with 70% to 84% of men and 30% to 60% of women reporting some form of sexual dysfunction. Although kidney transplantation improves the overall quality of life for patients receiving dialysis, it can have unexpected effects on sexual function owing to the use of immunosuppressive medications and comorbid illnesses. It is important to recognize these adverse effects and pre-emptively discuss them with patients to help mitigate consequent psychosocial discontent. Women of reproductive age will often recover fertility after kidney transplantation and therefore need to be empowered to prevent unwanted pregnancies and plan for a safe pregnancy if desired. Complications such as preeclampsia, pregnancy-induced hypertension, gestational diabetes, ectopic pregnancy, still birth, low birth weight, and preterm birth are more common in pregnant women with a kidney transplant. Careful monitoring for infection, rejection, and immunosuppressive dose adjustment along with comanagement by a high-risk obstetrician is of utmost importance. Breast-feeding is safe with most immunosuppressive medications and should be encouraged.

• Pregnancy
• contraception
• kidney transplant
• sexuality

Nowadays, the average human life expectancy is increasing. This applies to both healthy and chronically ill people. It is possible due to improvements in technology, living conditions, and better, more accessible medical care. As the number of patients with end-stage organ failure increases and due to great progress in modern transplantology, every year the number of transplantations rises worldwide. Organ transplantation is not only an ultimate form of therapy but also, especially nowadays, a life-saving procedure. Patients who have undergone transplantation need to face the problem of long-term immunosuppressive therapy on a daily basis, which prolongs the proper function of the grafted organ and prevents the development of graft-versus-host disease. On the other hand, numerous side effects are associated with the usage of these medicaments, among these are disturbances in sex-related hormones, therefore influencing fertility.

The rising need for treatment of end stage of organ failure results in an increased number of graft recipients yearly. The most commonly transplanted organs are kidney, heart, liver, bone marrow, lung and skin. The procedure of transplantation saves and prolongs the lives of chronically ill patients or at least improves the quality. However, following transplantation recipients must take immunosuppressive drugs on a daily basis. Usually, the immunosuppressive therapy comprises two or three drugs from different groups, as the mechanism of their action varies. Although the benefits of intake of immunosuppressants is undeniable, numerous side effects are associated with them. To different extents, they are neurotoxic, nephrotoxic and may influence the function of the reproductive system. Nowadays, when infertility is an urgent problem even among healthy pairs, transplant recipients face the problem of disturbance in the hypothalamic−pituitary axis. This review will provide an overview of the most common disturbances among the concentration of sex-related hormones in recipients of both sexes at different ages, including sexually immature children, adults of reproductive age as well as elderly women and men. We have also focused on the numerous side effects of immunosuppressive therapy regarding function and morphology of reproductive organs both in males and females. The current review also presents the regimen of immunosuppressive therapy and time since transplantation.

• Liver transplantation
• quality of life
• sexual function

• deceased donors
• liver clinical outcome
• quality of life

In patients with end-stage liver disease, hypogonadism and erectile dysfunction are often seen. This study was to determine the incidence of erectile dysfunction before and after liver transplantation (LT) with correlation to change in sex hormone levels from a Chinese cohort. This prospective longitudinal study was registered with The University of Hong Kong Clinical Trials Centre (HKUCTR-1563). The Institutional Review Board approval number is UW-12-273. The study period was from January 2012 to December 2016. Adult male patients with end-stage liver disease enlisted for LT were recruited on informed written consent. All recruited patients were to complete a cross-sectional cohort questionnaire—International Index of Erectile Function, version 5 (IIEF5)—and to receive serum sex hormone checks before and after LT. Twenty-eight patients who underwent LT were included in the analysis. The included patients had significantly reduced prolactin (p < .001) and 17-beta-estradiol (p = .024) after LT. There was also a significant drop of IIEF5 score at 1 month after LT, but the score returned to pre-LT level at 6 months. This study demonstrated that there was improvement in sex hormone levels after LT, namely, normalization of estradiol level and lowering of prolactin and progesterone levels. However, improvement in sex hormone levels did not translate into improvement of erectile dysfunction.

• end-stage liver disease
• erectile dysfunction
• hypogonadism
• liver transplantation
• sexual dysfunction
• treatment outcome

• cirrhosis
• erectile dysfunction
• portal hypertension
• sexuality

• Adult
• Austria
• Diabetes Complications
• Erectile Dysfunction/diagnosis
• Erectile Dysfunction/etiology
• Humans
• Hypertension, Portal/complications
• Liver/physiopathology
• Liver Cirrhosis/complications
• Liver Function Tests
• Logistic Models
• Male
• Middle Aged
• Prevalence
• Prospective Studies
• Risk Factors
• Severity of Illness Index

• endocrine dysfunction
• hormone
• liver transplantation

• Contraindications
• End Stage Liver Disease/diagnosis
• End Stage Liver Disease/etiology
• End Stage Liver Disease/surgery
• Europe
• Humans
• Liver Transplantation/methods
• Patient Selection
• Prognosis
• Risk Adjustment/methods

• Hepatitis C virus
• Liver allocation
• Liver transplantation
• MELD score
• Quality of life
• Sex
• Waitlist outcome
• Women’s health

• End Stage Liver Disease/surgery
• Female
• Graft Survival
• Humans
• Liver Transplantation/adverse effects
• Liver Transplantation/methods
• Liver Transplantation/statistics & numerical data
• Male
• Outcome Assessment, Health Care
• Perioperative Period
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Sex Factors
• Tissue and Organ Procurement/methods
• Waiting Lists

• L30 DK089607 NIDDK NIH HHS
• P30 DK026743 NIDDK NIH HHS

The evolution of liver diseases to end-stage liver disease or to acute hepatic failure, the evaluation process for liver transplantation, the organ allocation decision-making, as well as the post-transplant outcomes are different between female and male genders. Women’s access to liver transplantation is hampered by the use of model for end-stage liver disease (MELD) score, in which creatinine values exert a systematic bias against women due to their lower values even in the presence of variable degrees of renal dysfunction. Furthermore, even when correcting MELD score for gender-appropriate creatinine determination, a quantifiable uneven access to transplant prevails, demonstrating that other factors are also involved. While some of the differences can be explained from the epidemiological point of view, hormonal status plays an important role. Moreover, the pre-menopausal and post-menopausal stages imply profound differences in a woman’s physiology, including not only the passage from the fertile age to the non-fertile stage, but also the loss of estrogens and their potentially protective role in delaying liver fibrosis progression, amongst others. With menopause, the tendency to gain weight may contribute to the development of or worsening of pre-existing metabolic syndrome. As an increasing number of patients are transplanted for non-alcoholic steatohepatitis, and as the average age at transplant increases, clinicians must be prepared for the management of this particular condition, especially in post-menopausal women, who are at particular risk of developing metabolic complications after menopause.

• Liver transplantation
• Female gender
• Estrogens
• Model for end-stage liver disease score
• Creatinine
• Gender donor-recipient match

• Addison's disease
• Adrenocortical dysfunction
• Alcoholic liver disease
• Amenorrhoea
• Amiodarone
• Androgens
• Autoimmune diseases
• Cirrhosis
• Coagulation
• Cushing's syndrome
• Diabetes
• Gonadal dysfunction
• Gonadotropin
• Growth hormone
• Hepatitis
• Hyperlipidaemia
• Hyperthyroidism
• Hypogonadism
• Hypothyroidism
• Infertility
• Insulin resistance
• Liver transplantation
• Metabolic syndrome
• Non-alcoholic steatohepatitis
• Obesity
• Oestrogens
• Propylthiouracil
• Sexual dysfunction
• Steatosis
• Thyrotoxicosis
• progesterone

• Organ transplantation
• health related quality of life
• nursing.
• psychometric evaluation
• symptoms
• well-being

• Alcoholism/complications
• Erectile Dysfunction/etiology
• Hepatitis, Viral, Human/complications
• Humans
• Liver Cirrhosis/complications
• Liver Diseases/complications
• Liver Diseases/physiopathology
• Liver Diseases/therapy
• Liver Failure/complications
• Male
• Quality of Life
• Semen Analysis