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Cyclosporin-A-induced gingival overgrowth in renal transplant children
1Department of Pedodontics, Faculty of Odontology, Huddinge University Hospital, Karolinska Institutet, Sweden.
Insights
Cyclosporin-A (CsA) can cause gingival overgrowth in children after kidney transplants. Higher initial CsA doses increase this risk, highlighting the importance of monitoring drug administration.
Area of Science:
- Pediatric Nephrology
- Oral Medicine
- Pharmacology
Background:
- Renal transplant recipients often require immunosuppression.
- Cyclosporin-A (CsA) is a common immunosuppressant used in pediatric transplantation.
- Gingival overgrowth is a known side effect of CsA therapy.
Purpose of the Study:
- To assess the prevalence and characteristics of gingival overgrowth in pediatric renal transplant patients on CsA.
- To investigate the relationship between CsA dosage and the development of gingival overgrowth.
Main Methods:
- A cohort of pediatric renal transplant recipients on CsA for at least 12 months was studied.
- Data collected included demographics, transplant duration, CsA dosage (initial and current), and oral health parameters (plaque, inflammation, attachment loss, gingival overgrowth).
- Gingival overgrowth was defined by increased sulcus probing depth (pseudopockets).
Main Results:
- Thirteen percent of the children exhibited gingival overgrowth.
- Children with gingival overgrowth had received a significantly higher total CsA dose during the first six posttransplant months compared to those without overgrowth.
- No significant difference was noted in current oral CsA dose or blood trough levels between groups.
Conclusions:
- The development of CsA-induced gingival overgrowth in pediatric renal transplant patients is positively associated with the cumulative CsA dose administered in the early posttransplant period.
- Early high-dose CsA administration may be a critical factor in the pathogenesis of gingival overgrowth in this population.
Abstract:
Gingival overgrowth was assessed in renal transplant children, 19 boys and 13 girls, aged 2.5-18 yr, who had been on a cyclosporin-A (CsA)-based immunosuppressive regimen for at least 12 months. Data collected included number of posttransplant months, total CsA dose administered during the first 6 posttransplant months, oral dose and blood trough level of CsA on the day of examination, plaque accumulation (VPI%), gingival inflammation (GBI%), loss of attachment, and gingival overgrowth. Thirteen percent of the children exhibited gingival overgrowth characterized by one or more units with increased sulcus probing depth (> or = 4 mm), i.e. pseudopockets. The total amount of CsA administered during the first 6 posttransplant months was significantly higher in the children with gingival overgrowth than in those without. The study indicates that the development of CsA-induced gingival overgrowth is positively related to the total dose of the drug administered to the children during the first 6 posttransplant months.