Abstract
BackgroundThe oral health of organ transplanted patients before organ re-transplantation is largely unknown. This retrospective clinical study evaluates the necessity for intraoral surgical intervention and/or conservative treatment in candidates awaiting organ re-transplantation, both for graft failure and for reasons of another upcoming solid organ transplantation (renal or non-renal).MethodsFrom January 2015 to March 2020 n = 19 transplant recipients in evaluation on the waiting list for solid organ re-transplantation could be included in the retrospective case series study. Using clinical and radiological examinations, necessity for oral surgical or conservative dental treatment was evaluated. On the basis of anamnesis data, current kidney function, renal replacement treatment (RRT), and medication, a risk profile for several patient subgroups was created.ResultsThe clinical and radiological examinations showed a conservative and/or surgical treatment need in n = 13 cases (68.42%). In n = 7 cases (36.84%) surgical intervention was recommended due to residual root remnants (n = 5), unclear mucosal changes (n = 1), and periimplantitis (n = 1). In n = 16 recipients (84.2%) RRT (n = 15 hemodialysis; n = 1 peritoneal dialysis) had been performed. N = 14 recipients (73.68%) received immunosuppressants. In n = 1 patient (5.3%) displayed intraoral and n = 4 patients (21.1%) extraoral neoplasms due to drug-induced immunosuppression.ConclusionsSolid organ transplant recipients with renal failure present a complex treatment profile due to a double burden of uremia plus immunosuppressants. In cases of surgical treatment need a hospitalized setting is recommended, where potentially necessary follow-up care and close cooperation with disciplines of internal medicine is possible in order to avoid surgical and/or internal complications.
Highlights
The oral health of organ transplanted patients before organ re-transplantation is largely unknown
Kidney transplantation remains the gold standard for renal replacement treatment, prolonging life expectancy and quality of life [1]
Possible factors contributing to organ rejection may include prior sensitization of the recipient, the type of transplant donor, the duration of the ischemic phase after organ removal, human leukocyte antigen (HLA) incompatibility, lack of compliance, previous organ rejection, or inadequate immunosuppression [11]
Summary
The oral health of organ transplanted patients before organ re-transplantation is largely unknown. There has been a dramatic reduction in the incidence of acute rejection due to the introduction of potent immunosuppressive drugs in the past 3 decades. Risk factors for the development of acute rejection include pre-sensitization, presence of donor-specific antibodies, human leukocyte antigen (HLA) mismatches, pediatric recipient, African-American ethnicity, and delayed graft function [6]. The acute rejection takes place within the first days or weeks after transplantation It is caused by acute antibody production or acute T-cell activation [9]. Because of the introduction of more advanced and potent immunosuppressive drugs, the success rate of organ transplants is continually improving, lowering the incidence of organ rejection within the first year to approximately 7.9% [10]. Possible factors contributing to organ rejection may include prior sensitization of the recipient, the type of transplant donor (living vs. cadaveric), the duration of the ischemic phase after organ removal, HLA incompatibility, lack of compliance, previous organ rejection, or inadequate immunosuppression [11]
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