Kidney transplantation might improve mild to moderate erectile dysfunction (ED), new research suggests.

Investigators conducted a systematic review and meta-analysis of 20 observational studies involving 1695 kidney transplant recipients, including some previously receiving hemodialysis. A total of 589 (64%) patients reported some degree of ED on the International Index of Erectile Function (IIEF-5 or -15) prior to transplantation compared with 492 patients (53.4%) after transplantation.

Kidney transplantation was associated with a 21% lower risk of experiencing ED, Nikolaos Pyrgidis, MD, of G. Gennimatas Hospital, Aristotle University of Thessaloniki in Thessaloniki, Greece, and colleagues reported in the Journal of Urology. Kidney transplant recipients had a 2.5-fold higher likelihood of improvement in erectile function and experienced a mean 3.04-point increase in IIEF score after surgery. Men with severe ED had no significant improvement, however.

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“The underlying mechanisms of ED in end-stage renal disease patients are complex, including both organic and psychogenic factors,” Dr Pyrgidis’ team explained. Cardiovascular comorbidities, dysfunction of the hypothalamic pituitary-gonadal axis, neurovascular and endothelial alterations, and metabolic disorders all affect erectile function. In addition, long-term dialysis and psychosocial factors may worsen erectile function.

Kidney transplantation may reverse many of these factors by increasing renal clearance, hormone secretion, and quality of life, according to the researchers. Conversely, after transplantation, other risk factors, such as perioperative and graft complications as well as endothelial dysfunction from immunosuppressant agents, may emerge.

The strength of the evidence in this review was low due to methodological concerns and high heterogeneity among studies. To better understand ED in patients with end-stage kidney disease, the investigators encouraged future studies with standardized assessment of erectile function at multiple postoperative time points. They also requested consistent reporting of ED therapies, dialysis modalities and duration, transplant procedures, immunosuppression regimens, and perioperative and graft complications.


Pyrgidis N, Mykoniatis J, Sokolakis J, et al. Renal transplantation improves erectile function in patients with end-stage renal disease: A systematic review and meta-analysis. J Urol. 2021 Apr;205(4):1009-1017. doi:10.1097/JU.0000000000001577