Periodontal Clinical, Radiographic and Immunological Characteristics Post Liver Transplantation

Objectives: Post liver transplantation patients demonstrate impaired bone turnover, which might affect alveolar bone. Greater pro-inflammatory mediators are manifested systemically post-liver transplantation. The same mediators can be detected at sites of active periodontal disease, as part of the inflammatory process. The aim of this research was to characterize periodontal status of post liver transplantation patients clinically, radiographically and immunologically. Methods: 27 post-liver transplantation patients treated at the Liver Disease Department of Rambam Medical Center were invited to join our study. A full periodontal examination was performed at our Periodontal Department, and probing depth (PPD), clinical attachment level (CAL), and gingival overgrowth (GO) were recorded. Panoramic X-rays were taken and digitized using a computer-based measurement software to assess alveolar bone height. Gingival crevicular fluid samples were collected for a subset of this group from the periodontal pockets by inserting sterile paperpoints 30'. The samples were than taken to the laboratory for immunological processing. Results: Patients' mean age was 49.04±2.74 yrs. Mean time since transplantation was 70.17±9.72M. Mean bone loss was 4.52±0.57 mm, mean CAL 4.78±0.48 mm and mean PPD 3.44±0.14 mm. Mean GO score was 0.83±0.1, indicating moderate gingival overgrowth. Mean PgE2 levels were 226.49±20.61 ngr/sample, while mean TNF&alpha and IL-1&beta levels were 13.18±1.76 pgr/sample and 89.25±18.76 pgr/sample, respectively. Using Pearson correlation coefficient test, a negative association was found between transplantation time and bone loss (R=0.36, P=0.08). As for pro-inflammatory cytokines, a similar association was found between both TNF&alpha levels and bone loss (R=0.84, P=0.07) and between IL-1&beta levels and bone loss (R=0.86, P=0.06). Conclusion: Post liver transplantation patients present periodontal breakdown, as manifested clinically, radiographically and immunologically. Restoration of liver function following transplantation seems to have reversed some of the radiographic changes. Pro-inflammatory cytokines are good markers for alveolar bone loss in these patients.