The prevalence and risk factors of erectile dysfunction in kidney transplant recipients: A systematic review and meta-analysis.

BACKGROUND: Erectile dysfunction (ED) is a common complication in male kidney transplant recipients (KTRs), yet its prevalence and associated risk factors remain inadequately characterized. This study aimed to systematically evaluate the pooled prevalence of ED among KTRs and identify its significant risk factors. METHODS: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Scopus, CNKI, Wanfang, VIP, and CBM from inception to March 1, 2025. Observational studies reporting the prevalence or risk factors of ED in male KTRs using validated instruments (e.g., the International Index of Erectile Function) were included. Data synthesis was performed using a random-effects meta-analysis model. Subgroup analyses and meta-regression were applied to explore sources of heterogeneity. Publication bias was assessed using funnel plots and Egger test. RESULTS: A total of 28 studies involving 3520 male KTRs were included. The pooled prevalence of ED was 53.0% (95% confidence interval [CI]: 48.0%-57.9%). Among the analyzed factors, diabetes mellitus was significantly associated with ED (odds ratio = 3.80; 95% CI: 2.0700-6.9717). When the cutoff value was set at 50 years, age demonstrated the strongest association with ED (odds ratio = 7.22, 95% CI: 1.0273-50.7553). CONCLUSIONS: More than half of male KTRs experience ED, with advanced age and diabetes being key risk factors. These findings emphasize the need for routine sexual health assessments and targeted interventions in posttransplant care to improve quality of life.