Comparison of the efficacy of tadalafil in three different groups: patients on hemodialysis, first kidney transplant recipients, and second kidney transplant recipients

The efficacy of phosphodiesterase-5 inhibitors (PDE5Is) on the improvement of erectile dysfunction (ED) in second kidney transplant (KT) recipients has not been well investigated previously.

We aimed to compare the efficacy of tadalafil in three groups: hemodialysis (HD) patients, first KT recipients (KT1), and second KT recipients (KT2) with bilaterally ligated internal iliac arteries.

Age-matched men with erectile dysfunction were included in the study. Patients were divided into three groups: HD, KT1, and KT2. The International Index of Erectile Function 15 (IIEF-15) was used to assess baseline erectile function. Tadalafil was administered in a dose-escalation method for three months. Patients were reevaluated by the questionnaire at three months. The mean score evolution was compared between the study groups by one-way ANOVA.

The final analysis included 106 patients in three groups. There was no significant difference between the study groups regarding age, body mass index (BMI), blood pressure, and frequency of smoking, opium, or alcohol use. Tadalafil was safe and effective in all three groups. The mean IIEF score evolution in HD, KT1, and KT2 groups was 16.4 (58.7% increase from baseline), 19.3 (45.0% increase), and 20.4 (52.7% increase), respectively (P= 0.66).

Tadalafil is effective and safe in managing ED after the second kidney transplantation, where the internal iliac arteries are cut bilaterally. The response rate is similar to first kidney transplant recipients and hemodialysis patients.