Gingival Overgrowth as a complication of kidney transplantation – Nepali perspective

Amresh Thakur,Anup Lal Shrestha,Bikal Shrestha,Nabin Bahadur Basnet,Neesha Shrestha,Robin Bahadur Basnet,Robin Bahadur Basnet,Swosti Thapa

doi:10.3126/nmj.v2i2.26463

Abstract

Gingival Overgrowth is a known and common complication with multifactorial etiology seen in kidney transplant recipients. Gingival Overgrowth is induced in kidney transplant recipients by Cyclosporin A and Calcium Channel Blockers that are frequently prescribed to them as immunosuppressive and antihypertensive, respectively. There have been 1477 kidney transplantations in Nepal since the first kidney transplantation in 2008, but cases of gingival Overgrowth have not been reported in any publications. The aim of this review is to discuss the different aspects of gingival Overgrowth and its relevance to kidney transplant recipients of Nepal. This review will emphasize the need to examine the oral cavity of kidney transplant recipients. Genetic predisposition, oral health, and offending drugs are involved in the pathogenesis of gingival Overgrowth. This review discusses the pathogenesis, clinical features, and management aspects of gingival Overgrowth in kidney transplantation recipients. The reason for gingival Overgrowth not being reported in Nepal could be due to various reasons like favorable genes, good oral hygiene, or avoidance of drugs that cause gingival Overgrowth in kidney transplantation recipients. This could also be due to gingival Overgrowth being ignored by the patients and the treating doctors. These aspects are reviewed with reference to previous publications.

Highlights

Kidney transplantation is the best form of renal replacement therapy for eligible end-stage kidney disease (ESKD) patients
Drug-induced gingival overgrowth (GO) (DIGO) was first recognized in children treated with phenytoin in 1939.16 Three classes of drugs are known to be associated with GO as shown in Table 4.17 Drugs frequently prescribed to kidney transplantation recipients that are implicated as causing GO are – Cyclosporine A (CsA) and Calcium Channel Blockers (CCB)
Efforts suggested to reduce the risk of recurrence are the maintenance of good oral hygiene, the use of Chlorhexidine gluconate, the substitution of CsA and CCB with other medications, frequent professional recall appointments, and hygienic design of dental prosthetics.[44]

Summary

INTRODUCTION

Kidney transplantation is the best form of renal replacement therapy for eligible end-stage kidney disease (ESKD) patients. To best of our knowledge, there is no study or case report about oral cavity lesions in Nepali kidney transplant recipients. Among the 26 medical complications observed in the first 250 living donor kidney transplant recipients at TUTH, 2.7% had an aphthous ulcer and 2.2% had gum hypertrophy. These were the only two oral lesions so far reported in publication though oral lesions as listed in Table 2 are common complications seen in kidney transplant recipients.[5,6]. The incidence of GO in transplantation has been reported to be from 17.9% to 90% in various studies (Table 3)

51.72 Verapamil

Surgical Periodontal Treatment

CONCLUSIONS

Findings

17. Informational Paper