Transplant Patient Protocols 1

Lins, L., Bittencourt, Evangelista, Lins, R., Codes, Cavalcanti, Paran, and Bastos (2011) conducted an oral evaluation on all patients enrolled for Operative Liver Transplant (OLT) from 2003 to 2010. The following parameters were evaluated: clinical attachment loss, probing pocket depth, tooth mobility, and number of decayed/missing/filled teeth. All patients underwent panoramic radiography to assess intra-osseous lesions. Of the 131 patients, 99% were partially edentulous, requiring oral rehabilitation; 51% complained of chewing disturbances; and 48% experienced reduced salivary flow. Of the 131 patients, 21 were lost to follow-up (not sure what that means) at the stomatology unit prior to transplantation. Among the remaining 110 patients, 57% underwent dental treatment for periodontal disease, tooth decay, or elimination of foci of intraosseous infection. Of those 21 patients, 9 presented denture stomatitis lesions associated with poor hygiene in their upper denture prosthesis and oral manifestations of candidiasis. The most prevalent soft tissue lesions and sources of intraosseous infection are shown in Table 2. The results proved that mortality was significantly lower among those subjects who underwent oral health treatments (31%) versus non-treated patients (79%), particularly among subjects with more advanced liver disease.

Petti, Polimeni, Berloco and Scully (2013), conducted a literature search which was made through Solid Organ Transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients who were at risk of several diseases, principally attributable to immunosuppression. This global overview of SOT HSCT-associated orofacial diseases is aimed at providing a practical instrument for the oral healthcare management of SOTHSCT recipients. Patients receiving SOT or HSCT are liable to orofacial complications, principally because of the effects of immunosuppressive agents. Risk of

Transplant Patient Protocols 2

cancers in SOT recipients is increased for more than thirty different malignancies, including oral and lip cancers.

Gomez, Sanchez-Nuez, Sanchez, Corte, Aguado, Portal, Baltar and Alvarez-Grande (1997), aimed a study of thirty-eight renal transplant patients with cyclosporin induced gingival hyperplasia, who received 500 mg/day of Azithromycin for 3 consecutive days. The degree of gingival hyperplasia was classified as: 0, no gingival overgrowth; 1, mild overgrowth; 2, moderate overgrowth, and 3, severe overgrowth. Gingival bleeding and evolution of gingival hyperplasia were determined at 0 (pretreatment), 7, 30, 90 and 180 days. The degree of gingival hyperplasia was unrelated to the dose and levels of cyclosporin. Gingival hyperplasia improved in all patients. The degree of improvement was better when the degree of hyperplasia was lower. In 27 patients gingival hyperplasia remained absent 6 months later, 3 patients required a second course of treatment, and another required gingival surgery. Gingival bleeding, present in 28 patients when diagnosed, disappeared in all cases. No adverse effects were observed and it was proof that Azithromycin improves cyclosporin-associated gingival hyperplasia, especially when administered early in the process.