Gingival enlargement in children administered cyclosporine after liver transplantation

Cyclosporine, a potent immunosuppressant agent, has significantly reduced the morbidity and mortality rates associated with solid-organ transplantations. The major side effect of this drug in the oral cavity is gingival enlargement. Cyclosporine-induced gingival enlargement was reported by different transplant centers as varying from 7% to 80%. Many factors related to cyclosporine-induced gingival overgrowth have been investigated. However, controversies still exist. This study investigates the effects of cyclosporine on the gingival tissues of liver-transplant pediatric patients, determines the prevalence and severity of gingival overgrowth, and analyzes the relationship between gingival enlargement and possible risk factors.

Twenty-five children aged <4 years old (15 males and 10 females) with end-stage liver disease, and awaiting liver transplantation were selected for this study. During the pretransplant period, baseline data were collected including serum level of cyclosporine and gingival enlargement, plaque, and gingival bleeding indices. After liver transplantation, all subjects received <5 mg/kg cyclosporine as an immunosuppressant agent. The children had the same data collected immediately and 3, 6, and 12 months after liver transplantation.

The results show that the cyclosporine-induced gingival enlargement of these children is not statistically associated with their age, gender, gingival inflammation, or serum level of cyclosporine (P >0.05). The gingival enlargement was found to be significantly related to the plaque index at each time period until 12 months after liver transplantation (P <0.05). An increased tendency of gingival enlargement was found in the immediate post-transplant examination and at 3 months after liver transplantation.

Children administered cyclosporine after liver transplantation show that gingival enlargement is statistically more related to the plaque index than other factors such as age, gender, gingival inflammation, or the serum level of cyclosporine, which suggests that plaque control plays an important role in eliminating gingival enlargement in children who have undergone liver transplantation.