Erectile Dysfunction in Renal Transplant Recipients: Patterns of Recovery and Determinants of Outcome

Abstract Background Erectile dysfunction (ED) is highly prevalent in men with end-stage renal disease (ESRD) and significantly affects quality of life. Renal transplantation may improve erectile function; however, recovery is often incomplete and influenced by multiple clinical factors. Objectives To evaluate changes in erectile function following renal transplantation and to identify factors associated with recovery. Methods This observational study included 41 male renal transplant recipients at a tertiary care center. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire before transplantation and at six months post-transplant. Patients were stratified based on baseline ED severity. The association of comorbidities such as diabetes mellitus, hypertension, smoking status and duration of dialysis with post-transplant erectile outcomes was analyzed. Results Mean IIEF-5 scores improved significantly from 14.6 ± 5.7 before transplantation to 19.1 ± 5.6 at six months post-transplantation ( p < 0.001). The proportion of patients without ED increased from 7.3% to 36.6%, while moderate-to-severe ED decreased substantially. Patients with mild-to-moderate dysfunction demonstrated the greatest improvement, whereas those with severe baseline ED showed limited recovery. Diabetes mellitus, hypertension, smoking and prolonged dialysis duration showed associations with attenuated improvement in erectile function. A subset of patients remained sexually inactive despite objective improvement, indicating that factors beyond physiological recovery may contribute to sexual activity outcomes. Conclusions Renal transplantation was associated with significant but variable improvement in erectile function. Recovery appears to be associated with baseline ED severity, comorbidities and dialysis exposure. Comprehensive post-transplant care that addresses metabolic, vascular and psychosocial factors may help optimize sexual health outcomes in renal transplant recipients.