Gonadal dysfunction and infertility in kidney transplant patients receiving sirolimus
Gonadal dysfunction and infertility in kidney transplant patients receiving sirolimus
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DOI：
10.1007/s11255-009-9644-8
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发表时间：
2010-06-01
影响因子：
2
通讯作者：
Abouchacra, Samra
中科院分区：
文献类型：
--
作者：
Boobes, Yousef;Bernieh, Bassam;Abouchacra, Samra
西罗莫司是雷帕霉素抑制剂(mTOR-I)组的哺乳动物靶点的免疫抑制剂。最近的研究强调了西罗莫司对男性性腺功能的潜在影响。我们报告了西罗莫司引起的男性和女性肾移植患者的性腺功能障碍和不孕症的临床经验。在170名肾移植患者中，9名(5.3%)患者(6名男性和3名女性)正在接受西罗莫司治疗。无法获得两名男性患者的随访数据。1例未婚女性患者在移植后出现闭经，并在停用西罗莫司后恢复月经周期。其余6名已婚患者(4名男性和2名女性)在移植前都有孩子的父亲或怀孕，移植后平均5-12个月出现性腺功能障碍和不育。所有4名男性患者均停用西罗莫司，少精子症/无精子症完全恢复，生育能力恢复。两名已婚女性患者在移植后均出现闭经。1例女性患者月经周期恢复后停用西罗莫司。在接受西罗莫司治疗的这一小部分患者中，可逆性腺功能障碍和不孕不育的患病率在男性和女性中都很高。西罗莫司继发的不孕症被低估了，应该进一步研究。
Sirolimus is an immunosupressor of the mammalian target of rapamycin inhibitors (mTOR-I) group. Recent studies have emphasized a potential impact of sirolimus on male gonadal function. We report our clinical experience with sirolimus-induced gonadal dysfunction and infertility in both male and female kidney transplant patients. Of the 170 kidney transplant patients, nine (5.3%) patients (six males and three females) were receiving sirolimus. Follow-up data for two male patients were not available. The one unmarried female patient developed amenorrhea post-transplantation and had resumption of her menstrual cycles after discontinuation of sirolimus. The remaining six married patients (four males and two females), who all had fathered or conceived children in the pre-transplantation period, developed gonadal dysfunction and infertility on average 5-12 months after transplantation. Sirolimus was discontinued in all four male patients with full recovery of the oligo/azospermia and restoration of fertility. Both married female patients developed amenorrhea post-transplantation. Sirolimus was discontinued in one female patient with resumption of her menstrual cycles. In this small population of patients treated with sirolimus, the prevalence rate of reversible gonadal dysfunction and infertility was significant in both males and females. Infertility secondary to sirolimus is under-diagnosed and should be studied further.