Study on the effect of kidney transplantation on the health of the patients' offspring: a report on 252 Chinese children.

Even though the incidence of pregnancies in the female recipients is lower and also chronic renal disease in male patients is associated with impaired spermatogenesis, the health of the children born to these patients was not studied. In this report, we discuss information on the growth and development of offspring of 248 male and female kidney recipient patients. Physical and routine clinical measurements of the 252 offspring (129 male and 123 female) born to these transplantation patients were made along with the intelligence tests. In some of these children chest X-ray and immune indices were assessed. Among the recipients, 219 males fathered 223 children with an average birth weight of 3,255 ± 374 g and 29 female recipients gave birth to 29 children with an average birth weight of 2,923 ± 551. While most of these children were normal, we noticed a case of soft double toe, a case of short tongue tie, five cases of marginal mental retardation, three cases of proteinuria, six cases of microscopic hematuria, 15 cases of low hemoglobin, and 21 cases with recurrent respiratory tract infections. We conclude that kidney transplantation has no significant impact on the growth, development, health, and intelligence of the offspring born to recipients.

Effect of uremia on semen quality and reproductive function in humans.

In this study, we sought to evaluate the effect of uremia on semen quality and reproductive function in humans. For this purpose, 53 end-stage uremic patients were randomly selected. The semen samples were produced by masturbation. Fertility index (FI) was calculated according to the following formula: sperm density (×10(6)/ml) × sperm motility (%) × normal sperm morphology rate (% per 10,000). The semen samples of uremic patients were compared with those of fertile and infertile males. The results show that three patients failed to produce semen. There were no sperm found in four semen samples. The sperm motility, survival rate, sperm density, and normal sperm morphology rate of the remaining 46 patients were found to be significantly lower than those of controls. The uremic patients had the FI of 0.68(2.08) which was obviously lower than that of fertile 7.7(13.51) and infertile 4.13(5.77) males. It was, therefore, concluded that uremia caused a significant decline in sperm quality and reproductive function which resulted in consequential infertility in humans.

The decline of fertility in male uremic patients is correlated with low expression of the cystic fibrosis transmembrane conductance regulator protein (CFTR) in human sperm.

BACKGROUND: The present study was designed to investigate the possible association between infertility of male uremic patients and expression of the cystic fibrosis transmembrane conductance regulator (CFTR) protein in their sperm. METHODS: Semen was collected and analyzed. Serum levels of FSH, LH and testosterone were measured by radioimmunoassay. The sperm CFTR expressions of 21 uremic patients and 15 renal transplant patients were measured and compared with those of 32 healthy and 33 infertile men. RESULTS: Only 9 ± 5.9% of sperm from uremic patients expressed CFTR, significantly less than those of the renal transplant patients (29 ± 14.3%, P< 0.001), the infertile men (42 ± 20.7%, P< 0.001) and the healthy men (51 ± 20.5%, P< 0.001). Furthermore, significantly fewer sperm from renal transplant patients expressed CFTR than those of the infertile men (P< 0.05) and the healthy men (P< 0.01). LH levels in uremic patients were significantly higher than in all other groups, whereas FSH levels in uremic patients were only significantly higher than in infertile and healthy men. There was no significant difference in testosterone level among the four categories. CONCLUSIONS: Sperm CFTR expression is depressed in uremic patients but recovers to some degree after renal transplant along with some improvement in fertility, indicating a 'reversible' change. These results suggest that the CFTR expression rate in sperm is correlated with the decline of uremic patients' fertility, and may be considered as a potential marker to assess the fertility of male uremic patients.

Unwanted pregnancy among Chinese renal transplant recipients.

OBJECTIVES: To investigate the occurrence of unwanted pregnancies among renal transplant recipients and to identify major contributing factors. METHODS: A total of 647 women of childbearing age who had received a renal transplant at one of the five participating hospitals in China were enrolled in the study and administered a questionnaire that collected information on their reproductive health, pregnancies, and awareness and use of contraceptive methods. RESULTS: Of the 647 eligible patients, 98 (15%) reported 133 unwanted pregnancies post-transplantation. In this group (n = 98), despite an awareness of the available contraceptive measures, 56% had not applied any method of contraception, while 20% had relied on the rhythm method, and in only 12% of the cases male condoms had been used. The most common reason for not using contraception was a failure to realise that their reproductive function had been restored to normal soon after transplantation (19%). CONCLUSION In female renal transplant recipients, unprotected sex combined with incorrect judgment about their own reproductive potential post-transplantation were the major causes of unwanted pregnancies. The latter could be avoided through counselling about the risk pregnancy entails and the implementation of appropriate contraceptive measures.

Timing, conditions, and complications of post-operative conception and pregnancy in female renal transplant recipients.

The aim of this study was to explore the timing, conditions, and complications of post-operative conception and pregnancy among female renal transplant recipients in China. A cohort of 25 female renal transplant recipients who subsequently had successful pregnancies was randomly selected from eight organ transplantation centers in China. In this cohort, there were 38 post-transplant conceptions and 25 live births. The effects of conception and pregnancy on renal function as well as any effects of transplantation on delivery, prematurity, and maternal and infant health were investigated. Out of 38 conceptions after transplantation, seven ended in spontaneous abortion, six in artificial abortion, and 25 in single births, seven of which were premature (28%). The growth and development of all of the infants were normal. All the 25 received artificial (formula) feeding. Six patients had to return to hemodialysis therapy at 1-41 months after conception due to reduced function of the transplanted kidney. It appears best for female renal transplant recipients to wait at least for 2 years post-transplant before pregnancy. We found no significant effect on fetal growth and development. The incidence of premature births among female renal transplant recipients was high which might have an effect on transplant renal function and maternal health. Breast feeding is not considered suitable for these patients and was therefore not studied.

Measurements of serum pituitary-gonadal hormones and investigation of sexual and reproductive functions in kidney transplant recipients.

Objective. To investigate changes in serum pituitary-gonadal hormones and restoration of sexual and reproductive functions after successful kidney transplantation. Patients and Methods. Serum pituitary-gonadal hormones before and after kidney transplantation were measured in 78 patients with end-stage renal disease (ESRD) and in 30 healthy adults. Pre- and postoperative semen specimens of 46 male recipients and 15 male controls were collected and compared. Additional 100 married kidney transplant recipients without children were followed up for 3 years to observe their sexual function and fertility. Results. Serum PRL, LH, and T or E(2) levels gradually restored to the normal ranges in all kidney transplant recipients, and sperm density, motility, viability, and morphology significantly improved in the male recipients 4 months after successful kidney transplantation (P < .05). Thirty-three male recipients (55.93%) reobtained normal erectile function, and 49 kidney transplant recipients (61.25%) had children within the 3-year follow-up period. Conclusion. Successful kidney transplantation could effectively improve pituitary-gonadal hormone disturbance and sexual and reproductive dysfunctions of ESRD patients.

The influence of immunosuppressants on the fertility of males who undergo renal transplantation and on the immune function of their offspring.

AIM: To investigate the influence of immunosuppressants on the fertility of males who undergo renal transplantation as well as on the immune function of their offspring. METHODS: A survey was performed on the fertility of 164 male renal transplant recipients who underwent a long-term treatment with cyclosporine A (CsA), azathioprine (Aza) and prednisone (Pred). The immune function of the recipients' children was also surveyed. RESULTS: The 164 renal transplant recipients produced successful impregnation 15-204 (54.48+/-27.48)months after transplantation, resulting in the births of 167 children (three recipients fathered two children each), including 85 boys and 82 girls. Seven infants (4.2%) were premature. The weight of newborn infants was 2000-4600 (3274+/-395)g. Among the 167 children, 18 children were prone to respiratory tract infection. Examination of serum immunoglobulin from the children aged 1-3 years revealed that the IgA level was slightly lower than the normal reference range, but the difference was not significant (P>0.05). The IgM level of the children aged 7-12 years was higher than the normal reference range (P<0.01). Other immune indexes did not exhibit significant changes (P>0.05). CONCLUSION: A long-term treatment with small-dose immunosuppressants has no obvious effect on the fertility of males who undergo renal transplantation. However, whether immunosuppressants influence the immune function of the offspring of such transplant recipients remains to be clarified by long-term follow up and prospective studies.

Marital status and fertility of 185 male renal transplant recipients in China.

A questionnaire was designed to assess the effects of renal transplantation in men of reproductive age on marital status and fertility. The study sought to correlate recipients' marital status and fertility with the health of the recipients after the transplantation, the health of children they fathered after the procedure, and the functioning of the transplanted kidney. Male recipients (n = 243) who were single and of reproductive age before renal transplantation were selected from 2007 recipients of a renal transplant recorded in the authors' hospitals in China. Of the 243 surveyed, 185 completed the questionnaire and participated in follow-up in the clinic or by telephone. Their marital status and fertility were investigated. Of the 185 recipients, 69 got married 12-88 months (mean, 32.19 +/- 14.30 months) after renal transplantation, and 62 of 69 couples were actively attempting to become pregnant. Fifty-three patients fathered 54 children, including 1 pair of twins, 9-72 months (mean, 25.81 +/- 15.33 months) after marriage. The birth weights of the newborns ranged from 2500 to 4600 g (mean, 3395 +/- 456.80 g). These children developed well. Nine patients did not father any children, and 3 of these 9 cases were attributable to infertility in the wife. Seven patients were using contraceptives. Three recipients suffered from chronic graft rejection and resumed hemodialysis 2-11 years after they fathered children. In addition, 2 patients died after fathering 1 child: 1 from dysfunction of the transplanted kidney 9 years after birth of his child, and another in an accident 1 year after his child's birth. Our findings suggest that, like men without renal transplants, male recipients of renal transplants can get married and father children, and the transplantation procedure appears to have no significant effect on the children fathered afterwards, on the recipients' health, or on the functioning of the transplanted kidney. It is very important to indicate that, in addition to needing contraception if they do not conceive, male renal transplant recipients should expect fertility rates that are similar to those of the general population.

[Impregnate occasion for male renal transplant recipients].

OBJECTIVE: To explore the impregnate occasion for male renal transplant recipients. METHODS: Twenty-six male renal transplant recipients were divided into 3 groups according to the post-transplantation time and the administered dose of Cyclosporine A: 7 in Group A (less than 6 months after renal transplantation and at the dose of 4.1-6 mg/[kg x d]), 11 in Group B (6-24 months and 2.1-4 mg/[kg x d]) and 8 in Group C (longer than 24 months and 1.3-2 mg/[kg x d]). The semen of the patients were detected and compared with those of 12 normal volunteers. RESULTS: Statistically significant differences were observed in sperm motility and sperm head deformity between Group A and C (P < 0.05), but not in pH value and sperm volume, vitality and concentration among the 3 groups (P > 0.05). CONCLUSION: For male renal transplant recipients, 2 years or longer after the transplantation is the most suitable time for impregnation.

[Expression of integrin-linked kinase in prostate cancer and its significance].

OBJECTIVE: To investigate the expression of integrin-linked kinase (ILK) in primary prostate cancer and its clinical significance. METHODS: The expression of ILK was analysed in 50 prostate cancer and 16 benign prostatic hyperplasia samples by immunohistochemical staining. RESULTS: The positive percentage of ILK was 46.0% (23/50) in primary prostate cancer. The higher the grade and the clinical stage of the tumor, the lower the expression of ILK. The positive percentages of ILK were 9.1% (1/11) in the well differentiated type, 56.4% (22/39) in the moderately and poorly differentiated type (chi2 = 12.28, P < 0.01), 24.0% (6/25) in the well and moderately differentiated type, 68.0% (17/25) in the poorly differentiated type (chi2 = 9.74, P < 0.01), 22.6% (7/31) at the A + B stage and 84.0% (16/19) at the C + D stage (chi2 = 11.8, P < 0.01). But in benign prostatic hyperplasia, it was only 6.2% (1/16), significantly lower than in primary prostate cancer (46.0%) (chi2 = 8.27, P < 0.01). CONCLUSION: The abnormal expression of ILK plays an important role in the development of primary prostate cancer, and the detection of ILK may be useful for the judgement of tumor development and prognosis.

Morphological characteristics of spermatozoa before and after renal transplantation.

AIM: To investigate the changes of the spermatozoa ultrastructures before and after renal transplantation in uremic patients. METHODS: The sperm of five uremic patients before and after transplantation and four healthy volunteers were collected and examined by scanning electron microscopy. RESULTS: Abnormal spermatozoa were found in patients pre-transplantation; abnormalities included deletion of the acrosome, absence of the postacrosomal and postnuclear ring, dumbbell-like changes of the head, tail curling, and absence of the mitochondrial sheath in the mid-segment. After renal transplantation, most of the spermatozoa became normal. CONCLUSION: There are many abnormalities with regard to the appearance and structure of the head, acrosome, mitochondria and tail of the spermatozoa in uremic patients. The majority of the spermatozoa returned to normal after renal transplantation, but a few still presented some abnormalities possibly relating to the administration of immunosuppressants.

[Changes of semen quality in uremia patients].

OBJECTIVE: To evaluate the changes of the semen quality in uremia patients before renal transplantation. METHODS: The semen of 24 patients with uremia and 12 normal volunteers was analyzed. RESULTS: The semen volume, sperm motility, survival rate, density and morphological normality percentage were (2.5 +/- 0.4) ml, (13.4 +/- 3.9)%, (25.4 +/- 5.6)%, (20.6 +/- 4.5) x 10(6)/ml and (16.8 +/- 2.1)%, respectively, significantly lower than those of the normal group (P < 0.01). CONCLUSION: Semen qualities were lowered significantly and spermatogenesis severely affected in patients with uremia.

[A comparative study of male patient's sexual function before and after kidney transplantation].

OBJECTIVES: To investigate sexual function before and after kidney transplantation in patients with chronic nephrosis. METHODS: Eighty-six male patients were divided into 3 age groups: young-age group (Group A), middle-age group(Group B) and elder-age group(Group C). Sexual function, including potency, frequency and satisfaction of intercourse before and after the sickening, and after transplantation, were recorded in each group. RESULTS: All the patients were potent before suffering from nephrosis. The proportion of patients who were potent after catching the disease in Group A, B and C was 28.6%, 13.8% and 9.1%, respectively. Notably, the proportion of patients remaining potent after transplantation in Group A, B and C was 88.6%, 75.9% and 63.6%, respectively. CONCLUSIONS: Quality of sexual life is significantly improved after kidney transplantation. The younger the patients, the better the improvement.

[Effects of different dosages of cyclosporine A on the semen parameters of renal transplant patients].

OBJECTIVES: To evaluate the effects of different dosages of cyclosporine A (CsA) on the main semen parameters and sperm morphology of the patients after renal transplantation. METHODS: The semen of 18 patients after renal transplantation treated with different dosages of CsA was analyzed and the semen parameters and sperm morphology were compared with those of 12 normal volunteers. RESULTS: There was not significant difference between the main parameters of the patients treated with 1.5-3.0 mg.Kg-1.d-1 of CsA and 3.1-5.5 mg.Kg-1.d-1 of CsA and those of the volunteers (P > 0.05), but the rate of normal sperm morphology was significantly different between the two groups(P < 0.05). CONCLUSIONS: Different therapeutic dosages of CsA did not have any effect on most of the semen parameters of the patients after renal transplantation, but did affect the sperm morphology.