Oral diseases after liver transplantation: a systematic review and meta-analysis

Objective To conduct a systematic review and meta-analysis to evaluate the impact of liver transplantation on the occurrence and frequency of oral diseases in humans.Data sources The study query was performed on Medline/PubMed, Ovid, Cochrane Library and Embase databases, including the grey literature.Data selection Observational studies comparing the frequency of oral manifestations in post-liver transplantation patients versus reference population were eligible for inclusion.Data extraction and analysis The article selection, data extraction and quality assessment were executed by three independent investigators. A random-effects meta-analysis was carried out for computation of relative risks of oral malignancies (standardised incidence ratio [SIR] and 95% confidence interval [CI]).Data synthesis Among 248 studies identified, 11 met the eligibility criteria and six were included in the meta-analysis. Opportunistic fungal infections (Candida spp.) and lesions with malignant potential were reported to be more frequently prevalent after liver transplantation. Calculations indicated that after liver transplantation, the patients have a fivefold increased risk for oral cancer occurrence compared to the general population (SIR = 5.006; 95% CI 2.803 to 8.94; p <0.001).Conclusions The findings suggest that liver transplantation increases the risk of oral malignancies and the frequency of other mucosal lesions.