Oral mucosal lesions in liver transplant recipients and controls
Jaana Helenius-Hietala1,2, Hellevi Ruokonen2, Lisa Grönroos2, Harri
Rissanen3, Miira Vehkalahti1,4, Liisa Suominen3,5, Helena Isoniemi6, Jukka H.
Meurman1,2
University of Helsinki, Institute of Dentistry, Helsinki, Finland
University Central Hospital, Department Of Oral and Maxillofacial Diseases,
Helsinki, Finland
3 National Institute for Health and Welfare, Finland
4 University of Oulu and Oulu University Hospital, Oulu, Finland
5 University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
6 Helsinki University Central Hospital, Transplantation and Liver Surgery Clinic, Helsinki,
Finland
1
2 Helsinki
Objectives: Liver transplant recipients have permanent immunosuppression to prevent
graft rejection. Immunosuppressive and also other non-transplant medications may
predispose to oral diseases. However,data on oral mucosal health in liver transplant
recipients is limited. The aim of our study was to investigate oral mucosal
lesions(=OML) in liver transplant recipients compared to controls.
Methods: We recruited 84 liver transplant recipients (64 chronic liver disease, 20 acute
liver failure) for clinical oral examination in a cross-sectional, case-control study. Their
oral health had been clinically examined prior to transplantation. Prevalence of OML
was assessed in different etiologies of liver diseases and different immunosuppressant
groups compared to that of controls selected from a nationwide survey in Finland
(n=252). Statistical associations were studied using either Fisher's exact test or MannWhitney U-test. Risk factors for oral mucosal lesions were further evaluated using
logistic regression.
Results: OML were more frequent in liver transplant recipients than in controls (43% vs.
15%, p<0.001 and the use of steroids raised the prevalence to 53%. Drug-induced
gingival overgrowth was the single most common lesion, and its prevalence was
significantly higher in patients using cyclosporine compared to tacrolimus (30% vs. 5%,
p=0.007) and even higher with simultaneous calcium channel-blockers together with
cyclosporin or tacrolimus (47% vs. 8%, p=0.002), respectively. Lesions with malignant
potential such as drug-induced lichenoid reactions, oral lichen planus-like lesions,
leukoplakias, or ulcers occurred in 13% of patients with chronic liver disease and in 6%
of controls. Every third chronic patient showed reduced salivary flow and more than half
of all patients were positive for Candida, a risk higher with steroids.
Conclusions: In conclusion, the high frequency of OML after liver transplantation is not
only explained by immunosuppressive but also by other medications. Since dry mouth
affects oral health and OML may have potential for malignant transformation, annual oral
examinations are indicated.
Acknowledgements: This study was financially supported by a travel grant from the
Finnish Dental Society Apollonia.
This abstract has been presented at the Frontiers in Oral Medicine meeting in Orlando,
Florida, USA, 9. – 12.4.2014.