Comparison of the efficacy of tadalafil in three different groups; patients on hemodialysis, first kidney transplant recipients, and second kidney transplant recipients

Abstract

Introduction: The efficacy of phosphodiesterase-5 inhibitors (PDE5Is) on the improvement of erectile dysfunction (ED) in second kidney transplant (KT) recipients has not been studied before. Objectives: We aimed to compare the efficacy of tadalafil in three groups: hemodialysis (HD) patients, first KT recipients (KT1) and second KT recipients (KT2) with bilaterally ligated internal iliac arteries (IIAs). Patients and Methods: Age-matched men with ED were included in the study. Patients divided into three groups; HD, KT1 and KT2. The international index of erectile function 15 (IIEF-15) questionnaire was used to assess the baseline erectile function. Tadalafil was administered in a dose-escalation method for three months. Patients were reevaluated by the questionnaire at three months. The mean score evolution was compared between the study groups by Kruskal-Wallis H test. Results: Total number of 106 patients in three groups was included in the final analysis. There was no significant difference between the study groups in terms of age, body mass index (BMI), blood pressure and frequency of smoking, opium, or alcohol use. Tadalafil was safe and effective in all three groups. The mean IIEF score evolution in HD, KT1 and KT2 groups was 16.4 (58.7% increase from baseline), 19.3 (45.0% increase) and 20.4 (52.7% increase), respectively. Conclusion: Tadalafil is effective and safe in the management of ED even after the second kidney transplantation when the IIAs are cut bilaterally. The response rate is similar to first KT recipients and HD patients. Trial Registration: The trial protocol was approved by the Thai Clinical Trials Registry (https://www.thaiclinicaltrials.org/show/TCTR20220310008, ethical code# IR.SBMU. UNRC.1396.43).