Increased Risk for Infections after Liver Transplantation among Patients without Pre-Transplant Dental Screening

Abstract

Introduction: Infections cause considerable morbidity after liver transplantation (LT). Acute liver failure (ALF) is a rapidly progressing life-threatening condition where pre-transplant dental evaluation is not always possible. We investigated how missing pre-transplant dental screening and treatment in ALF correlates with infectious complications after LT. Methods: Medical and dental data came from hospital records, and infection data from the Finnish LT registry. The follow-up was until February 2011. Of 51 ALF patients (LT between 2000-2006), 35 (group 1) did not have dental treatment before LT due to their weak medical condition. 16 (group 2) patients had dental treatment before LT. Results: 26/35 (74%) patients in group 1 suffered 60 infection episodes and 7/16 (43%) patients in group 2 suffered 13 infection episodes (n=0.0007). The cumulative infection incidence (number of patients with at least one infection episode) exceeded 80% in group 1 at 9 months post-transplant, but remained under 30% in group 2 (Figure 1). After adjustment for either pre-transplant factors alone or both pre- and post-transplant factors; such as, e.g. etiology of ALF, waiting time, MELD, and immunosuppression; the infection risk in group 1 increased to respectively 8.17-fold (95% CI 2.19-30.6) and 8.54-fold (95% CI 1.82-40.1) compared to that in group 2. This increased risk involved a variety of bacterial, viral, and fungal infections of various sources both < 6 and >6 months after LT (Table 1). Of other factors tested, only pre-transplant dialysis proved independently associated with infections.Table: [Post-transplant infections between the groups]Figure: [Infection incidence after LT between the groups]Conclusion: Without dental treatment before LT was associated with a significantly increased post-transplant infection risk, even after adjustment for various confounders. Our findings support the need for dental examination and treatment before LT even in ALF taking into account patient's medical condition.