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

Abstract

BackgroundAim 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 Methods169 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.ResultsThe 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.ConclusionsTime 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. Key words:Immunosuppression, organ transplantation, periodontitis, periodontal bacteria.

Contribution of herpesviruses in the progression of periodontal and peri‐implant diseases in systemically healthy individuals

“…Bacteria and viruses are more often detected in oral biofilm samples of immunocompromised compared with systemically healthy individuals . However, studies have shown increased concentrations of viruses in the subgingival oral biofilm of systemically healthy patients with periodontal and peri‐implant diseases compared with their respective controls.…”

“…Bacteria and viruses are more often detected in oral biofilm samples of immunocompromised compared with systemically healthy individuals. 21,22 However, studies 18,20 have shown increased concentrations of viruses in the subgingival oral biofilm of systemically healthy patients with periodontal and peri-implant diseases compared with their respective controls. It is therefore evident that immunosuppression and bacterial colonization in the oral biofilm is not solely responsible for the development and progression of periodontal and peri-implant diseases; and presence of viruses in the subgingival oral biofilm of systemically healthy individuals may also play a role in this context.…”

Pathological Characteristics of Periodontal Disease in Patients with Chronic Kidney Disease and Kidney Transplantation

“…Conversely, a recent study evaluated the relationships between immunosuppressive agents and periodontal pathogenic bacteria in patients following solid organ transplantation [124]. Although it should be noted that the study population included three different types of organs (kidney, liver, and lung), the study demonstrated that changes in the levels of periodontal pathogenic bacteria dependent on immunosuppressive agents.…”

Cyclosporine A – Induced gingival overgrowth and proliferating cell nuclear antigen expression in experimental periodontitis

“…3 The etiology of CsA-induced gingival overgrowth still remains incompletely explained 4 and many risk factors have been associated with its development and progression. 5 The accumulation of dental plaque 6 and inflammatory mediators associated with periodontal disease 7,8 have been suggested as local factors of gingival overgrowth. The studies are not conclusive about the requirement of accumulation of dental plaque for the initial lesion or if it is a consequence of gingival overgrowth.…”

“…On the other hand, patients post solid organ transplantation, under medication with Cyclosporine, demonstrated worse periodontal condition compared to patients without Cyclosporine, since immunosuppression changed prevalence of selected potentially periodontal pathogenic bacteria. 6 The histopathological studies of CsA-induced gingival overgrowth have been demonstrated the enlargement of epithelial and connective tissue. However, most of them, investigated the influence of fibroblasts 10,11 and inflammatory cells on this process 12 ; the importance of epithelial hyperplasia on gingival overgrowth have been infrequently studied.…”