Importance of the Dental Treatment in Renal-Transplant Recipients~Single Center Experience~

Abstract

Introduction The second position of the cause of death of renal transplant (RTx) recipients is an infection in our country. Therefore, the management of the infection before and after the RTx is important in improving the prognosis of RTx recipients. By the way, most of RTx of our country are living RTx, and there is extremely little cadaveric RTx, and the mean waiting time of cadaveric RTx is extremely long with approximately 15 years. As for the living RTx, the preoperative close inspection is carried out for plan surgery elaborately, but, in cadaveric RTx, the pre-operative examination of the patients is often insufficient for emergency surgery. During a RTx wait, many patients conduct the systemic evaluations such as endoscopy, the computed tomography in hemodialysis (HD) centers, but the treatment of oral lesions such as tooth caries, periodontal disease is not performed enough in many cases. It is with infection focus by an immunosuppressive drug after RTx when we perform RTx without these being treated enough and it is sometimes aggravated and comes to have a poor prognosis. Therefore the treatment of the oral lesion of RTx recipients is important. Patient The RTx program has been started in our department in May, 2006. 90 RTx (71 living, 19 cadaver) have been performed so far. Tooth caries was detected just before RTx and extracted a tooth in oral surgery promptly in 7 cadaveric RTx patients. Also, four living and six cadaveric RTx patients were treated for oral surgery because of gingival hypertrophy, tooth caries after RTx. Recently, we experienced one RTx patient whom a brain abscess developed in from tooth caries 11 years after cadaveric RTx. Case 56 years old, male. He has suffered HD for 17 years. He has been performed cadaveric RTx in October, 2006. In April, 2017, he was increased predonine dose because of severe proteinuria. And tooth caries occurred in the middle of July, 2017. Subsequently, over 39 degrees fever, headache, and vomiting developed, points out a brain abscess by onset, in head CT and MRI in August, 2017. The same Klebsiella pneumoniae was detected in bacterial culture of examination of cerebrospinal fluid, the tooth caries and was thought with the brain abscess that occurred by transmission from tooth caries. Conclusion It may occur for a brain abscess as a cause for severe tooth caries and periodontal disease under immunosuppressive status after RTx. Also, when severe tooth caries or periodontal disease is pointed out before RTx to a RTx candidate, we evade or may have to postpone RTx. Therefore we should usually examine an oral lesion in a RTx candidate and recipient, and it is necessary to cure as needed.