Solid organ transplants/tissue (grafts) are indicated when specific organs/tissues (e.g., kidney, liver, pancreas, intestine, heart, lung, tendons, nerves) are failing or dysfunction.
Hematopoietic stem cell transplants (HSCT, formerly known as bone marrow transplants [BMT]) are usually indicated for neoplasms, some autoimmune disorders, and some immunodeficiency disorders. HSCT uses either an autologous “self” donor graft or a “nonself” donor (allogeneic) graft.
Transplants are usually characterized as autologous (a transplant from and to oneself), isogenic or syngenic (a transplant from and to an identical twin), allogenic (a transplant between individuals who are not genetically identical) and xenogenic (a transplant where the donor and the recipient are of different species).
The longer the patient has survived without complications after a transplant, the more stable the graft and the patient.
Rejection of a transplant is a very serious complication and can occur at various times after transplantation.
- Hyperacute rejections can occur minutes to hours after transplantation
- Acute rejections occur within days to weeks; and
- Chronic rejections occur months to years post-transplant.
Although a transplant has been performed, some underlying pathologic conditions may still be present or may reemerge. Furthermore, some types of transplants may predispose the patient to other diseases affecting the same or other organ systems.
For example, heart transplant patients may develop ischemic heart disease and have a diminished vagal response, or patients with longstanding renal failure may still have an increased susceptibility to bacterial endocarditis.
Patients receiving solid organ transplants may develop types of cardiovascular disease, including coronary artery disease, hypertension, diabetes, neuropsychiatric complications, as well as complications associated with corticosteroid use.
Patients receiving allogenic HSCT may develop complications such as end-organ damage (e.g. sinusoidal obstructive syndrome (SOS) of the liver, and interstitial pneumonitis or alveolar hemorrhage) and graft-versus-host disease involving eyes, vagina, joints, lungs, and musculoskeletal tissues.
Oral complications are common when patients are severely immune suppressed or exhibit immune dysfunction. Common complications include lesions associated with Graft-Versus-Host Disease , different herpes virus infections , candidiasis , side effects due to medications.
Fungal infections are more common immediately post-transplant; herpes simplex virus infections usually occur within 1-2 months; other herpes infections may occur within 1-10 months post-transplant.
Possible bone marrow suppression and, for pre-transplant patients, severity of the end-stage disease should be addressed.
A complete blood cell count with a differential cell count and disease-specific laboratory values are always indicated for both pre- and posttransplant patients.
All transplant recipients must receive immunosuppressive therapy for various periods of time. Most allogeneic solid organ transplant recipients require lifelong maintenance immunosuppression. Long‐term immunosuppression is usually not required in allogeneic HSCT, and autologous HSCT generally requires no immunosuppression at all.
The most common medications include cyclosporine analogs, tacrolimus, sirolimus, everolimus, azathioprine, mycophenolate mofetil, mono- and polyclonal antibodies, and corticosteroids.
All immunosuppressive medications are associated with significant side effects, and most are nonspecific.
In addition, concomitant antimicrobial (e.g., antibiotic, antiviral, antifungal) therapy is often indicated to treat opportunistic pathogens, such as cytomegalovirus (CMV), pneumocystis jiroveci, candida albicans, and herpes simplex virus (HSV),
- Oral Health Care Considerations
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- Osiak M, et al. Frequency of pathologic changes in the oral cavity in patients subjected to long‐term pharmacologic immunosuppressive therapy after kidney, liver, and hematopoietic cell transplantation
- Ward BB, et al. Long‐term postoperative bleeding after dentoalveolar surgery in the pretransplant liver failure patient. J Oral Maxillofac Surg. 2006;64(10):1469–1474