背景:活体肾脏捐赠(LKD)面临终末期肾病患者的持续需求,强调LKD成长和成功的重要性。尽管活体肾脏供体通常表现出优异的存活率,很少有研究探讨LKD后长期性功能障碍的发展。
目的:本研究旨在分析男性和女性活体肾脏捐献者5年性功能障碍结局的差异,利用TriNetX数据库,来自多个美国医疗保健组织的联合电子病历网络。
方法:一项倾向评分匹配的队列研究比较了2013年12月至2022年12月成年男性和女性活体肾脏捐献者45年性功能障碍的结果。队列在年龄上匹配;性别;种族和民族;糖尿病,心血管,泌尿生殖系统,和精神合并症;生活方式相关因素;以及可能影响正常性功能的药物。主要结果包括性欲下降的风险比(HR),性功能障碍(男性勃起功能障碍的复合物,射精障碍,阴道痉挛/性交困难,不孕症,性高潮障碍,唤醒/欲望障碍),和性传播疾病。次要结果评估了与配偶或伴侣的性咨询和人际关系问题。
结果:匹配的队列包括2315名患者(男性,female),平均年龄为42.3±12.5岁。在5年,男性捐赠者的性功能障碍HR显著较高(HR,3.768;95%置信区间,1.929-7.358)。1%的男性患者发生勃起功能障碍,而阴道痉挛/性交困难影响<1%的女性患者。其他性障碍,性欲下降,性传播疾病,性咨询和配偶间咨询的发生率没有显着差异。
结论:男性活体肾脏捐献者在捐献后5年面临更高的性功能障碍风险。虽然LKD仍然是一个安全可行的选择,临床医生和捐献者应注意与捐献后性功能障碍的潜在关联.进一步的研究可能会增强对活体肾脏捐献者福祉的支持。
BACKGROUND: Living kidney donations (LKDs) face a persistent demand for patients with end-stage renal disease, emphasizing the importance of LKDs\' growth and success. Although living kidney donors generally exhibit excellent survival rates, little research has explored the development of long-term sexual dysfunction following LKD.
OBJECTIVE: This study aimed to analyze differences in 5-year sexual dysfunction outcomes between male and female living kidney donors, utilizing the TriNetX database, a federated network of electronic medical records from multiple U.S. healthcare organizations.
METHODS: A propensity score-matched cohort study compared 45-year sexual dysfunction outcomes in adult male and female living kidney donors from December 2013 to December 2022. Cohorts were matched on age; sex; race and ethnicity; diabetes, cardiovascular, genitourinary, and psychiatric comorbidities; lifestyle-related factors; and medications that may impact normal sexual functioning. Primary outcomes included hazard ratio (HR) for decreased libido, sexual dysfunction (composite of male erectile dysfunction, ejaculatory disorders, vaginismus/dyspareunia, infertility, orgasmic disorders, arousal/desire disorders), and sexually transmitted diseases. Secondary outcomes assessed sex counseling and interpersonal relationship issues with spouses or partners.
RESULTS: The matched cohorts included 2315 patients each (male, female), and the mean age was 42.3 ± 12.5 years. At 5 years, male donors had a significantly higher HR for sexual dysfunction (HR, 3.768; 95% confidence interval, 1.929-7.358). Erectile dysfunction occurred in 1% of male patients, while vaginismus/dyspareunia affected <1% of female patients. Other sexual disorders, decreased libido, sexually transmitted diseases, and incidences of sexual and interspousal counseling were not significantly different.
CONCLUSIONS: Male living kidney donors faced a higher risk of developing sexual dysfunction 5 years after donation. While LKD remains a safe and viable alternative, clinicians and donors should be mindful of the potential association with sexual dysfunction postdonation. Further research may enhance support for the well-being of living kidney donors.