Determinants of gingival overgrowth severity in organ transplant patients. An examination of the rôle of HLA phenotype.
The role of HLA phenotype as a risk factor for drug-induced gingival overgrowth was investigated in a cohort of 172 transplant recipients. Clinically significant overgrowth warranting surgical correction was observed in 72 patients (42%). Using stepwise regression modelling, 6 clinical parameters were identified as significant risk factors for the severity of gingival overgrowth. These were; age, sex, creatinine plasma level, duration of therapy, papilla bleeding index and concomitant medication with a calcium channel blocking drug. 3 HLA alleles were also identified as risk factors when adjusted for other clinically significant risk factors (HLA -DR2, A24, B37). However, when the p-values for the HLA variables were corrected to compensate for the use of multiple significance testing, only HLA-B37 remained statistically significant at the 5% level. Organ transplant patients are at risk of developing gingival overgrowth, with approximately 25% medicated with cyclosporin alone requiring corrective gingival surgery. This figure more than doubles in patients concomitantly medicated with a calcium blocking drug. The data at present available would suggest that the severity of gingival overgrowth is also significantly associated with the HLA-B37 phenotype.
Thomason
J M
JM
Department of Restorative Dentistry, University of Newcastle, Newcastle-upon-Tyne, UK. J.M.Thomason@Newcastle.ac.uk
Seymour
R A
RA
Ellis
J S
JS
Kelly
P J
PJ
Parry
G
G
Dark
J
J
Wilkinson
R
R
Ilde
J R
JR
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002121:Calcium Channel Blockers / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects*; D004357:Drug Synergism; D005260:Female; D005885:Gingival Hyperplasia / Q000139:chemically induced / Q000276:immunology; D019214:Gingival Overgrowth / Q000139:chemically induced* / Q000276:immunology*; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology*; D015234:HLA-A Antigens / Q000276:immunology; D059871:HLA-A24 Antigen; D015235:HLA-B Antigens / Q000276:immunology; D059912:HLA-B37 Antigen; D015804:HLA-DR4 Antigen / Q000276:immunology; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D010512:Periodontal Index; D010641:Phenotype; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D018709:Statistics, Nonparametric; D013997:Time Factors
D002121:Calcium Channel Blockers; D006680:HLA Antigens; D015234:HLA-A Antigens; D059871:HLA-A24 Antigen; D015235:HLA-B Antigens; D059912:HLA-B37 Antigen; D015804:HLA-DR4 Antigen; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine