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Organ and Cell Transplants - Oral Health Care Considerations

  • 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.

Stable Graft:

  • 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.

Drug actions and 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

Side effects from immunosuppressive medications#

  • 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

Common oral complications associated with solid organ/tissue and hematopoietic stem cell transplant (HSCT).#

  • 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 Camera icon and Kaposi's sarcoma Camera icon.

Dental treatment for patients with HSCT:#

  • 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) Camera icon, including oral complications.
  • Address possible salivary gland complications.

Medical Complexity Status - Organ and Cell Transplants#

Organ and Cell
 Drugs/ drug

See Medical Complexity Status for more information.

Related Pages#