Oral lesions in organ transplant patients

Abstract

Patients who have undergone organ transplantation can present with a variety of oral lesions that appear to be related either directly to their medication or arise as a consequence of drug-induced immunosuppression. Such lesions include hairy leukoplakia, an increased propensity to both fungal and viral infections and a high incidence of malignant change, especially lip cancer. Cyclosporin remains the immunosuppressant of choice in most transplant patients. Gingival overgrowth is the main unwanted oral effect associated with cyclosporin. Some 30% of dentate transplant experience this problem, which is further compounded by concomitant medication with a calcium channel blocker. This review appraises the various oral problems that can arise in this group of patients and emphasises the importance of regular oral screening and the establishment of links with the various transplant teams.

Detection of the Epstein–Barr Virus (EBV) by In situ Hybridization as Definitive Diagnosis of Hairy Leukoplakia

“…HL is not exclusively associated to AIDS, this lesion is related with immunosuppression in general, especially in transplanted HIV-negative patients [11][12][13]. In our results, we diagnosed one case of HL in an HIV-negative renal transplant recipient (Table 1).…”

“…It was initially described as being exclusive to AIDS patients [7,8,10]. Later, however, HL was diagnosed in immunosuppressed HIV-negative patients, particularly in organ transplant recipients [11][12][13].…”

Adverse Drug Reactions in the Orofacial Region

“…An increased frequency of lesions with epithelial dysplasia of the lips (but not oral mucosa) has been observed in some but not all iatrogenically immunosuppressed patients (King et al, 1995;Seymour et al, 1997).…”

“…AfricanAmericans may be at particular risk (Ulmer and Garvey, 1992;Gabb et al, 1996;Sabroe and Black, 1997;Lapostolle et al, 1998;Vleeming et al, 1998). The tissue swelling associated with ACE inhibitor therapy may be due to a rise in levels of bradykinins and/or altered levels or function of C1 esterase inhibitor (Ebo and Stevens, 1997;Seymour et al, 1997).…”

“…More rarely, mucormycosis and aspergillosis may cause thrush-like areas or other lesions in patients on long-term immunosuppressive therapies (Dreizen et al, 1992;Scully, 1992;Seymour et al, 1997).…”