Association of time under immunosuppression and different immunosuppressive medication on periodontal parameters and selected bacteria of patients after solid organ transplantation

BACKGROUND: Aim of this study was to investigate the association of the time under immunosuppression and different immunosuppressive medication on periodontal parameters and selected periodontal pathogenic bacteria of immunosuppressed patients after solid organ transplantation (SOT). MATERIAL AND METHODS: 169 Patients after SOT (lung, liver or kidney) were included and divided into subgroups according their time under (0-1, 1-3, 3-6, 6-10 and >10 years) and form of immunosuppression (Tacrolimus, Cyclosporine, Mycophenolate, Glucocorticoids, Sirolimus and monotherapy vs. combination). Periodontal probing depth (PPD) and clinical attachment loss (CAL) were assessed. Periodontal disease severity was classified as healthy/mild, moderate or severe periodontitis. Subgingival biofilm samples were investigated for eleven selected potentially periodontal pathogenic bacteria using polymerasechainreaction. RESULTS: The mean PPD and CAL as well as prevalence of Treponema denticola and Capnocytophaga species was shown to be different but heterogeneous depending on time under immunosuppression (p < 0.05). Furthermore, only the medication with Cyclosporine was found to show worse periodontal condition compared to patients without Cyclosporine (p < 0.05). Prevalence of Porphyromonas gingivalis, Tannerella forsythia and Fusobacterium nucleatum was reduced and prevalence of Parvimonas micra and Capnocytophaga species was increased in patients under immunosuppression with Glucocorticoids, Mycophenolate as well as combination therapy. CONCLUSIONS: Time under and form of immunosuppression might have an impact on the clinical periodontal and microbiological parameters of patients after SOT. Patients under Cyclosporine medication should receive increased attention. Differences in subgingival biofilm, but not in clinical parameters were found for Glucocorticoids, Mycophenolate and combination therapy, making the clinical relevance of this finding unclear

Association between the time after transplantation and different immunosuppressive medications with dental and periodontal treatment need in patients after solid organ transplantation.

OBJECTIVE: The aim of this study was to investigate the association of time after transplantation and different immunosuppressive medications with dental and periodontal treatment needs in patients after solid organ transplantation (SOT). METHODS: After lung, liver, or kidney transplantation, patients were included and divided into subgroups based on the time after SOT (0-1, 1-3, 3-6, 6-10, and >10 years) and immunosuppression (tacrolimus, cyclosporine, mycophenolate, glucocorticoids, sirolimus, and monotherapy vs combination). Dental treatment need was determined by the presence of carious lesions, while periodontal treatment need was diagnosed based on a Periodontal Screening index score of 3-4. The overall treatment need included both the dental and/or periodontal treatment needs. Statistical analysis was performed using the Kruskal-Wallis test and chi-squared test (P < .05). RESULTS: A total of 169 patients were included after SOT. A dental treatment need of 44%, a periodontal treatment need of 71%, and an overall treatment need of 84% were detected in the total cohort. Only patients with >10 years after SOT had a lower dental treatment need compared to the other groups (P = .02). All other comparisons of dental, periodontal, and overall treatment needs were comparable between subgroups depending on time since SOT. Furthermore, no statistically significant differences were found in terms of the dental, periodontal, or overall treatment needs following the administration of different immunosuppressive medications. CONCLUSION: The high treatment need of patients after SOT, irrespective of the time since transplantation, suggests insufficient dental and periodontal treatment before and maintenance after organ transplantation. Furthermore, immunosuppressive medication was not associated with the treatment need.

Periodontal pathogenic bacteria and aMMP-8 findings depending on periodontal conditions of patients before and after liver transplantation.

BACKGROUND: The aim of this single-center cross-sectional study was to detect the prevalence of selected periodontal pathogenic bacteria and active matrix metalloproteinase-8 (aMMP-8) level in patients before (preLTx) and after liver transplantation (postLTx). METHODS: Periodontal pocket depth (PPD) and clinical attachment loss (CAL) were assessed. Subgingival biofilm samples were analyzed using polymerase chain reaction (PCR) to detect 11 common periodontal pathogens. Gingival crevicular fluid (GCF) samples were analyzed with enzyme-linked immunosorbent assay (ELISA) to determine aMMP-8 level and assigned to a scoring system: score 0: 0-8 ng/ml, score 1: 8-20 ng/ml, and score 2: >20 ng/ml. The following were used for the statistical analysis: t test, Mann-Whitney U test, Fishers test (α = 5 %). RESULTS: In total, 110 patients (preLTx: n = 35, postLTx: n = 75) could be included in the study. Periodontal findings were not significantly different between groups. In microbiological analysis, a significantly higher prevalence of Campylobacter rectus in preLTx group was detected (p = 0.03). Significantly more patients with score 0 in postLTx group (p = 0.024) and significantly more patients with score 1 in preLTx group were found (p = 0.004). Furthermore, aMMP-8 concentrations for patients with moderate periodontitis were significantly lower in postLTx group compared to preLTx group (p = 0.045). Additionally, in postLTx group, aMMP-8 concentration was significantly higher in patients with severe periodontitis compared to those with no/mild periodontitis (p = 0.016). CONCLUSION: LTx appears to affect aMMP-8 level, but not bacterial findings in patients after LTx. CLINICAL RELEVANCE: Determination of aMMP-8 level in patients after LTx with immunosuppressive medication might lead to wrong interpretation of the results.