Alterações Bucais em receptores de transplante renal

Abstract

The objective of this study was to know the orofacial lesions and alterations of renal transplant recipients who underwent kidney transplantation in the Renal Transplant Center in São Paulo city, and to analyze them according to the underlying disease that led to transplantation, type of transplantation, time elapsed from transplantation and immunosuppressive regimen used. In addition, we identified the incidence of oral and odontogenic complaints and complications after kidney transplantation and the impact of dental treatment previous to renal transplantation in the occurrence of these complications. A cross-sectional observational study was performed, including 317 renal transplant recipients (GE) and 100 healthy individuals (CG). The same researcher collected demographic data, medical history and dental history, and performed physical orofacial examination. The DTMF index, the ICP index and the presence of soft tissue oral lesions were assessed. The renal transplant recipients mean age was 45.6 years old, there were 165 (52.1%) females, and the majority (272/317, 85.8%) were transplanted more than 6 months, with kidneys mostly received from deceased donors (241/317,76.0%). The most commonly used immunosuppressive regimen was tacrolimus, mycophenolate sodium and prednisone (150/317, 47.3%). GE had more soft tissue lesions than GC (20.8% X 9%), with erythematous candidiasis being the most frequent lesion (21/317), followed by ulcers (8/317), pseudomembranous candidiasis (7/317), recurrent herpes simplex (5/317), angular cheilitis (4/317) and drug induced gingival overgrowth (2/317). Complaints and oral complications after transplantation were reported by 34 subjects of the GE. The most frequent was "aphtous ulcer", reported by 18 of them. Eleven GE participants reported odontogenic complications: 5 cases of gingivitis, 3 cases of pericoronitis, 2 cases of toothache and 1 of dentin sensitivity. Seven individuals were hospitalized for non-odontogenic oral problems and no subjects reported hospitalization due to odontogenic causes. Among the 317, 54 participants received dental care prior to renal transplantation and there was no association between this care and the report of occurrence of complaints and oral complications after transplantation. We conclude that the RTR showed a higher prevalence of teeth with indication of extraction, dental mobility, dental calculus and soft tissue lesions than GC. The most common changes in this group were xerostomia, bilateral parotid enlargement and candidiasis. The mucosal ulcerations in renal transplant recipients were associated with the use of everolimus. While caries lesion, tooth mobility and gingival retraction were associated with longer time of transplantation. The pre-transplantation dental care did not influence the occurrence of oral and dental complications after transplantation, nor hospitalization due to oral complications.