Oral health of patients suffering from end-stage solid organ insufficiency prior to solid organ re-transplantation: a retrospective case series study

• Published in: BMC oral health Vol. 21; no. 1; pp. 1 - 547
• Main Authors: Moest, Tobias, Lutz, Rainer, Jahn, Arne Eric, Heller, Katharina, Schiffer, Mario, Adler, Werner, Deschner, James, Weber, Manuel, Kesting, Marco Rainer
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 24-10-2021; BioMed Central; BMC
• Subjects: Antigens; Complications and side effects; Dentistry; Graft rejection; Grafts; Hemodialysis; Hospitals; Hypertension; Immunosuppression; Immunosuppressive agents; Inflammation; Kidney failure; Kidney transplantation; Kidney transplants; Maxillofacial surgery; Mucosa; Nephrology; Oral health; Oral hygiene; Organ transplantation; Patients; Periodontal disease; Peritoneal dialysis; Renal failure; Renal function; Risk factors; Statistical analysis; Teeth; Transplantation of organs, tissues, etc; Uremia; Variables; Germany
• ISSN: 1472-6831; 1472-6831
• DOI: 10.1186/s12903-021-01908-2

Abstract
Background
The 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).
Methods
From 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.
Results
The 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.
Conclusions
Solid 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.