Sexual function and reproduction in kidney transplantation

Abstract

Chronic kidney disease is characterized by sexual dysfunction and reduced fertility owing to the abnormal hypothalamic–pituitary–gonadal axis. Owing to the rapid restoration of fertility after transplant, prospective transplant recipients should be counseled regarding posttransplant contraception. Although intrauterine devices and hormonal contraceptives are the most commonly used forms of temporary contraception, the mode of contraception should be individualized. The effects of pregnancy on renal allograft and that of immunosuppression on the mother as well as on the fetus should be discussed with every prospective recipient of child-bearing age during pretransplant workup. Management of pregnancy in a transplant recipient involves a multidisciplinary approach involving nephrologists, transplant surgeons, and obstetricians. Guidelines recommend withholding pregnancy for at least 1 year after transplant. The prerequisites to planning conception in a female allograft recipient include steady allograft function, blood pressure under adequate control, and proteinuria of less than 1 g/day for 1 year. The immunosuppression should be suitably modified before conception to ensure that the patient is not taking any fetotoxic medications. This includes replacing mycophenolate mofetil with azathioprine. Close monitoring of calcineurin inhibitor drug levels is required during pregnancy. The mode of delivery could be either normal vaginal delivery or Cesarean section, depending on the decision made by the obstetrician. The benefits and risks associated with breastfeeding the baby should be discussed.