Objectives: Cyclosporin-A (CyA) and tacrolimus (Tacro) are calcineurin inhibitors (CNI) and the main immunosuppressants after liver transplantation (LT). Systemic corticosteroids (cort) are also used to avoid rejections. We investigated oral manifestations in patients taking these medications with hypothesis that differences exist in oral health status depending on the immunosuppressant.
Methods: 77 post-LT patients (51 men, 26 women; median age 55.9 years) were recruited. Chronic liver disease (74%) was the main etiology for LT. Oral examination was conducted including saliva and bacterial sampling and use of questionnaire. Statistical associations were studied between groups on different type of immunosuppressant using chi² and logistic regression.
Results: In CNI+cort-group higher prevalences for Candida infection (p=0.037), gingival overgrowth, oral lesions, and alveolar bone loss (ABL) were found than in CNI alone (see table). The same parameters except ABL were more common in CyA than in Tacro. In CyA-group significantly more gingival overgrowth occurred (p=0.044). When a calcium channel blocker was added to CyA then even more gingival overgrowth was observed (46.2%, p=0.0169).
| CNI n=55 | CNI+cort n=18 | CyA n=37 | Tacro n=36 |
Candida infection | 44.2% | 72.2%* | 57.1% | 44.1% |
Gingival overgrowth | 20.0% | 27.8% | 31.6%* | 11.8% |
Oral lesions | 30.9% | 50.0% | 42.1% | 29.4% |
ABL ≥2 mm | 31.5% | 44.4% | 29.7% | 38.2% |
*p<0.05
Statistical risk factors for mucosal lesions in all patients were number of teeth (OR=0.916, 95%CI=0.9-1; p=0.017), Candida infection (OR=9.8, 95%CI=1.5-66.5; p=0.019),and alcohol use (OR=4, 95%CI=1-16.3; p=0.050). Patients with chronic liver disease had lower resting salivary flow rates than those with an acute disease (mean flow 0.34 ml/min vs. 0.53 ml/min, p= 0.032). Of all patients 45.5% were positive for periodontal pathogens with no difference between the groups.
Conclusion: Systemic corticosteroids increased the prevalence for oral manifestations; particularly significantly more Candida occurred. Use of CyA increased the prevalence of mucosal lesions. Supported by HUS EVO Grant T1020Y0011.