The authors each declare that they have no conflict of interest. The study received no external funding.
Sirolimus May Reduce Fertility in Male Renal Transplant Recipients
Article first published online: 28 JUN 2008
© 2008 The Authors Journal compilation © 2008 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 8, Issue 7, pages 1471–1479, July 2008
How to Cite
Zuber, J., Anglicheau, D., Elie, C., Bererhi, L., Timsit, M.-O., Mamzer-Bruneel, M.-F., Ciroldi, M., Martinez, F., Snanoudj, R., Hiesse, C., Kreis, H., Eustache, F., Laborde, K., Thervet, E. and Legendre, C. (2008), Sirolimus May Reduce Fertility in Male Renal Transplant Recipients. American Journal of Transplantation, 8: 1471–1479. doi: 10.1111/j.1600-6143.2008.02267.x
- Issue published online: 28 JUN 2008
- Article first published online: 28 JUN 2008
- Received 10 December 2007, revised 27 February 2008 and accepted for publication 14 March 2008
- Quality of life;
- renal transplantation;
- reproductive endocrinology and infertility;
Assessment of sex hormones in organ transplant recipients suggests that sirolimus may impair testicular function. The aim of this study was to evaluate the frequency and severity of sirolimus-associated alterations in sperm parameters and their impact on fathered pregnancy rate. An observational study was carried out in male patients aged 20–40 years who received a kidney transplant during 1995–2005. Patients were sent a questionnaire by post, and sperm analysis was proposed. The fathered pregnancy rates according to the immunosuppressive regimen were estimated and compared using the Poisson model. Complete information was obtained from 95 out of 116 recipients. Patients treated with sirolimus throughout the post-transplant period had a significantly reduced total sperm count compared to patients who did not receive sirolimus (28.6 ± 31.2 × 106 and 292.2 ± 271.2 × 106, respectively; p = 0.006), and a decreased proportion of motile spermatozoa (22.2 ± 12.3% and 41.0 ± 14.5%, p = 0.01). Moreover, the fathered pregnancy rate (pregnancies/1000 patient years) was 5.9 (95% CI, 0.8–42.1) and 92.9 (95% CI, 66.4–130.0) in patients receiving sirolimus-based and sirolimus-free regimens, respectively (p = 0.007). Of six patients in whom sirolimus treatment was interrupted, only three showed a significant improvement in sperm parameters. Sirolimus is associated with impaired spermatogenesis and, as a corollary, may reduce male fertility.