- For patients awaiting transplants, address the underlying end-stage disease.
- ⚠️ Immediate post-transplant period – No elective dental care.
- ⚠️ Presence of chronic rejection – No elective dental care.
- Consult with patient’s transplant team surgeon/coordinator.
- Address possible immune suppression, bone marrow suppression, and adrenal suppression.
- Be aware of drug actions and drug interactions.
- Azathioprine – Increased susceptibility to infections and increased bleeding tendencies when bone marrow suppression is present
- Corticosteroids – Possible adrenal suppression and immunosuppression,
- Cyclosporine – Gingival overgrowth Image; avoid medications metabolized by liver cytochrome P450 3A (e.g., erythromycin, clarithromycin, metronidazole, azole antifungals)
- Mycophenolate mofetil – Avoid broad-spectrum antibiotics
- Sirolimus – Same as cyclosporine, but without gingival overgrowth
- Tacrolimus – Same as cyclosporine, but without gingival overgrowth
- Azathioprine – Bone marrow suppression, hepatoxicity
- Corticosteroids – Adrenal suppression, elevated BP, dyslipidemia, hyperglycemia, ocular changes, osteoporosis, exacerbation of PUD
- Cyclosporine – Hepatoxicity, nephrotoxicity, elevated BP
- Mono- and polyclonal antibodies – Leukopenia, pulmonary edema, nephrotoxicity, fever, chills
- Mycophenolate mofetil – Leukopenia
- Sirolimus – Hyperlipidemia, hypertriglyceridemia
- Tacrolimus – Hepatoxicity, nephrotoxicity, neurotoxicity, hyperglycemia, elevated BP
- Treat or refer as appropriate for treatment of viral, fungal and deep fungal oral infections.
- Be aware of, treat or refer patients with more extensive caries, periodontal disease, oral ulcerations, dysgeusia and dysphagia, oral mucositis, salivary gland dysfunction and oral dryness, and opportunistic malignancies, such as basal cell carcinoma, lymphoma and Kaposi's sarcoma .
- HSCT conditioning (before the transplant) is associated with high dose chemotherapy and total body irradiation.
- Address veno-occlusive liver disease.
- Address Graft-Versus-Host Disease (GVHD) , including oral complications.
- Address possible salivary gland complications.
|Organ and Cell|
| Drugs/ drug|
See Medical Complexity Status for more information.
- Medical Disorders
- Majhail NS, et al. Indications for autologous and allogeneic hematopoietic cell transplantation: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant. 2015;21(11):1863–1869.
- Bowen J, et al. The pathogenesis of mucositis: updated perspectives and emerging targets. Support Care Cancer. 2019;27(10):4023–4033.
- Cocero N, et al. Is it safe to remove teeth in liver transplant patients without antibiotics? A retrospective study of 346 patients. J Oral Maxillofac Surg. 2019;77(8):1557–1565.
- Elahimehr R, et al. Hematopoietic Stem Cells and Solid Organ Transplantation. Transplant Rev (Orlando). 2016;30(4):227–234.
- Ferreira MH, et al. Association of oral toxicity and taste changes during hematopoietic stem cell transplantation: a preliminary study. Support Care Cancer. 2020;28(3):1277–1287.
- Jessop H, et al. General information for patients and carers considering haematopoietic stem cell transplantation (HSCT) for severe autoimmune diseases (ADs): A position statement from the EBMT Autoimmune Diseases Working Party (ADWP), the EBMT Nurses Group, the EBMT Patient, Family and Donor Committee and the Joint Accreditation Committee of ISCT and EBMT (JACIE). Bone Marrow Transplantation (2019) 54:933–942.
- 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