末期肝病男性病患因肝移植而改善賀爾蒙和勃起功能
簡佑全1、陳堯俐2、江恆杰1、林屏沂2
1彰化基督教醫院 外科部 泌尿科；2彰化基督教醫院 移植暨外科研究中心
IMPROVEMENT OF HORMONAL PROFILE AND ERECTILE FUNCTION IN MALE RECIPIENTS AFTER LIVING DONOR LIVER TRANSPLANTATION
You-Chiuan Chien, MD1, Yao-Li Chen, MD2, Heng-Chieh Chiang, MD1,Pin-Yi Lin, DR2
1Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; 2Transplant Medicine and Surgery Research Centre, Changhua Christian Hospital, Changhua, Taiwan
Purpose: Hypogonadism and sexual dysfunction are common clinical presentation in male liver transplant candidate. The aim of the study was to evaluate the effects of living donor liver transplantation(LDLT) on testosterone, sex hormone-binding globulin(SHBG), free androgen index(FAI) and erectile function in LDLT recipient.
Materials and Methods: Male candidates for a LDLT were asked to participate in laboratory and questionnaire survey. Among the 43 eligible men, 41 (95%) completed the data collection during January 2014 to February 2015 in Changhua Christian Hospital, Changhua city, Taiwan. In the prospective study, serum levels of SHBG, and FAI of 41 male adult recipients were measured between 8 and 10 o'clock in the morning of the operation day and 1, 3 months after LDLT. The 5-item version of the International Index of Erectile Function (IIEF-5) Questionnaire was used before transplantation and six months after operation. Other clinical data were collected via chart review.
Results: SHBG level in the pre-transplant group was 68.49 35.99 nmol/L and decreased to 34.62 17.39 (p < 0.01) at 1 month, 44.74 23.53 (p < 0.01) at 3 month after LDLT. FAI in the pre-transplant group was 16.75 10.10. FAI increased to 32.75 15.56 (p < 0.01) at 1 month and 25.23 10.26 (p < 0.01) at 3 month after LDLT. The lower MELD Score (Model for End-Stage Liver Disease) was associated with worse pre-transplant testosterone level, FAI and better improvement of hormonal profile after transplant. The IIEF-5 scores significantly increased after LDLT (from 11.7 7.7 before LDLT to 14.7 7.5 after LDLT, p <0.01).
Conclusions: Serum level of SHBG decreased and FAI increased after LDLT. The LDLT also results in improvement in erectile function. These data need further validation in larger trials.