Dysfunction of the hypothalamic-pituitary-gonadal axis (HPGA) is a key contributor to hypogonadism and sexual dysfunction in patients with end-stage renal disease (ESRD). Kidney transplantation is the preferred treatment for ESRD and has demonstrated beneficial effects in improving gonadal dysfunction and abnormal sex hormone levels in transplant recipients. However, inappropriate use of immunosuppressants may have adverse effects on gonadal function. For female kidney transplant recipients planning pregnancy, careful adjustment of immunosuppressive regimens-balancing risks and benefits-is essential. In male kidney transplant recipients, phosphodiesterase-5 inhibitors, intracavernosal alprostadil injections, and penile prosthesis implantation have been shown to be relatively safe options for managing erectile dysfunction. Despite these advancements, research on the treatment of hypogonadism in kidney transplant recipients remains limited, underscoring the urgent need for further studies to explore more effective therapeutic approaches. This review aims to provide an in-depth analysis of research progress on gonadal function changes in kidney transplant recipients, offering valuable insights for clinicians to optimize patient management.

Dysfunction of the hypothalamic-pituitary-gonadal axis (HPGA) is a key contributor to hypogonadism and sexual dysfunction in patients with end-stage renal disease (ESRD). Kidney transplantation is the preferred treatment for ESRD and has demonstrated beneficial effects in improving gonadal dysfunction and abnormal sex hormone levels in transplant recipients. However, inappropriate use of immunosuppressants may have adverse effects on gonadal function. For female kidney transplant recipients planning pregnancy, careful adjustment of immunosuppressive regimens-balancing risks and benefits-is essential. In male kidney transplant recipients, phosphodiesterase-5 inhibitors, intracavernosal alprostadil injections, and penile prosthesis implantation have been shown to be relatively safe options for managing erectile dysfunction. Despite these advancements, research on the treatment of hypogonadism in kidney transplant recipients remains limited, underscoring the urgent need for further studies to explore more effective therapeutic approaches. This review aims to provide an in-depth analysis of research progress on gonadal function changes in kidney transplant recipients, offering valuable insights for clinicians to optimize patient management.

Normothermic machine perfusion (NMP) is currently a research hotspot of organ preservation in the field of transplantation. Its safety and effectiveness of organ preservation have been clinically validated especially for preserving marginal donor organs. Various unique advantages of NMP are offered for in vitro organ function assessments, maintenance and organ injury repairing. Within the field of organ medicine, precise clinical interventions based upon in vivo or in vitro researches are implemented through an in vitro organ support system. With an aid of extracorporeal organ support system, an independent extracorporeal circulation system could be established for single or multiple organs more efficiently and safely. And physiological supports and other interventions for target organs are performed. Organ gene editing therapy, organ cell therapy, organ chemotherapy, organolytic virus therapy and organ physiological support therapy are all disciplines of organ quarantine therapy. This emerging theory provides a novel treatment for clinical organ diseases. This review summarized the use of NMP technology based upon the concepts and applications of organ medicine. Also the applications of organ isolation and protection therapy were discussed for organ transplantation and other research fields.

Objective:To explore the long-term preservation value and repair effect of normothermic machine perfusion (NMP) on clinically discarded kidneys.Methods:A case of clinical discarded donor kidney was collected, and NMP was carried out in vitro for 9 hours with recovered blood. The dynamic changes of renal appearance, blood gas and biochemistry analysis of perfusate and renal pathology were recorded. Results:In the second to fifth hour of NMP, the appearance of renal was pink and ex vivo normothermic perfusion assessment score (EVNP) was grade Ⅰ. While, the sixth hour and beyond of NMP, the appearance of kidney turned to dark red and EVNP was grade Ⅲ. The renal perfusion blood flow maintained above 150 ml/min in the first 6 hours and decreased significantly after that, and at the end, was only 50 ml/min. During the whole process of perfusion, urine output was maintained at about 100 ml/h. PO 2 remained above 100 mmHg in the first 5 hours of perfusion and from the 6th hour, was lower than 80 mmHg and continued to decline, and was close to 0 at the end of perfusion. The results showed that although the K + concentration changes in blood and urine in the first 5 hours of NMP had a good consistency, the lactic acid level had been rising. In addition, there was no significant change in the histopathology at the fourth hour of perfusion compared with that before zero-point puncture, and the fibrinous thrombus in glomeruli was improved compared with that before perfusion. However, at the sixth hour after perfusion and before the end of perfusion, the pathological changes of renal tissue were significantly worse. There were a large of thrombosis in glomerular blood vessels, renal tubular atrophy and acute tubular necrosis. Conclusions:NMP can realize the evaluation of extended criteria donors before transplantation, and it proves the feasibility and repair potential of NMP in kidney to a certain extent. At the same time, NMP also provides a new way to expand the source of donor kidney and to pre-treat organ in vitro.