Objective: There are few longitudinal data on the endocrine changes which occur after liver transplantation. We have therefore studied the impact of orthotopic liver transplantation (oLTX) on the hypothalamic-pituitary-gonadal hormone axis and sex steroid metabolism in men.
Patients and study design: Ten male patients with end-stage liver failure due to alcohol induced cirrhosis (n = 2), virus-induced cirrhosis (n = 5), primary biliary cirrhosis (n = 1) and idiopathic cirrhosis (n = 2) were included in a prospective study analysing the impact of oLTX on endocrine status. They were studied before and after oLTX with a mean follow-up of 11.6 months (range 4-23) following transplantation.
Measurements: Serum levels of LH, FSH, testosterone (TE), free TE, PRL, cortisol, oestradiol (E2) and sex hormone binding globulin (SHBG) were analysed with commercially available radioimmunoassays in all individuals before and after oLTX. Gonadotrophin releasing hormone stimulation tests were done in 5 patients before and after oLTX. Additionally, a complete urological assessment with a detailed questionnaire on sexual function was obtained from all individuals.
Results: Prior to oLTX, endocrine status was invariably abnormal, the most prominent finding being a pathological decrease of TE in 90% and of free TE in all cases. After successful oLTX, all individuals had physiological levels of TE and of free TE which increased twofold (P < 0.01) and tenfold (P < 0.0001), respectively. Additionally, serum gonadotrophin (LH/FSH) levels increased in the majority of patients, while E2 decreased following oLTX. Endocrine changes extended beyond the hypothalamic-pituitary-gonadal hormone axis, as shown by a decrease in PRL (P < 0.02) and SHBG (P < 0.01) after transplantation. GnRH tests revealed normal stimulation of LH and FSH before and after oLTX in all cases. Libido, potency and frequency of sexual intercourse improved significantly after oLTX in the majority of patients.
Conclusions: These findings demonstrate the ability of the hypothalamic-pituitary-gonadal hormone axis and sex steroid metabolism to resume physiological function following orthotopic liver transplantation in men. Correspondingly, sexual function returns to normal in the majority of patients, despite significant alterations prior to orthotopic liver transplantation.