Gingival hyperplasia in renal allograft recipients receiving cyclosporin-A and calcium antagonists.
Although it is established that the immunosuppressant cyclosporin-A (CsA) and calcium antagonists [Nifedipine (Nif) and Diltiazem (Dz)] can independently induce gingival enlargement, little has been documented on the significance of the salivary CsA levels and the combined effect of CsA and a calcium antagonist upon gingival tissues. In the present cross-sectional investigation, clinical periodontal parameters and the pharmacologic profiles of CsA, Nif, and Dz were determined for 66 renal transplant recipients. Subjects were divided into the following groups: Group (Gp) 1: CsA [n = 18]; Gp 2: CsA + Nif [n = 15]; Gp 3: CsA + Dz [n = 12] and a negative Control Gp 4: azathioprine [n = 21]. A gingival enlargement score was assessed for each patient from study models using a hyperplastic index (HI). Pharmacologic profiles included CsA whole blood and whole saliva levels as measured by fluorescence polarization immunoassay. The HI scores between Gp 1, 2 and 3 were not significantly different. However, when compared with controls (Gp 4), there was a significant difference in HI and all individual groups (Gp 1, 2, 3) (p < 0.05). Gingival hyperplasia was only weakly related to plaque and calculus but was unrelated to CsA dose (mg/kg/day), duration of CsA therapy (months), CsA blood or saliva levels (ng/ml), or the concurrent administration of a Nif or Dz. Gingival enlargement was found to occur in 49% of subjects who were either on CsA or CsA and a calcium antagonist. It is concluded that CsA alone or in combination with a calcium antagonist caused a significant increase in gingival enlargement compared with controls.(ABSTRACT TRUNCATED AT 250 WORDS)
King
G N
GN
Dental Unit, Royal Melbourne Hospital, Australia.
Fullinfaw
R
R
Higgins
T J
TJ
Walker
R G
RG
Francis
D M
DM
Wiesenfeld
D
D
D000328:Adult; D003430:Cross-Sectional Studies; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood / Q000493:pharmacokinetics; D003728:Dental Calculus; D003774:Dental Plaque Index; D004110:Diltiazem / Q000009:adverse effects*; D004347:Drug Interactions; D005260:Female; D005885:Gingival Hyperplasia / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D003765:Models, Dental; D009543:Nifedipine / Q000008:administration & dosage / Q000009:adverse effects*; D010512:Periodontal Index; D012463:Saliva / Q000737:chemistry / Q000378:metabolism
D016572:Cyclosporine; D004110:Diltiazem; D009543:Nifedipine