title: An investigation into the need for supplementary steroids in organ transplant patients undergoing gingival surgery. A double-blind, split-mouth, cross-over study.
abstract: Organ transplant patients are frequently medicated with triple immunosuppressive therapy that includes both cyclosporin and the corticosteroid, prednisolone. Many of these patients experience gingival overgrowth that necessitates surgical intervention. Chronic dosing with corticosteroids can lead to suppression of the hypothalamic-pituitary axis, and subsequent adrenocortical suppression. To circumvent possible suppression, supplementary steroids are administered to such patients prior to so-called "stressful events". We have examined the need for supplementary steroids in 20 organ transplant patients undergoing gingival surgery under local anaesthesia to correct their drug-induced gingival overgrowth. All patients were operated upon in the first half of the morning. Prior to gingival surgery, resting blood pressure (BP) and serum ACTH concentrations were determined. Immediately before surgery patients received either intravenous hydrocortisone 100 mg or placebo in random, double-blind order. Each patient required 2 gingivectomies and thus acted as their own placebo control. BP was measured at various time points throughout surgery and upto 2 h postoperatively. On completion of surgery, a further blood sample was taken to determine ACTH concentration. There was no significant difference (p>0.05) between placebo and hydrocortisone treatments for BP and ACTH measurements. No patient experienced any symptoms that were suggestive of adrenocortical suppression. One patient did experience postural hypotension prior to gingival surgery, but this is attributed to his antidepressant medication. We can conclude from this study that immunosuppressed organ transplant patients taking the maintenance dose of prednisolone (5-10 mg/day) do not require corticosteroid cover prior to gingival surgery under local anaesthesia. We would however, advocate monitoring of their blood pressure throughout the procedure.
authors.affiliation: Department of Restorative Dentistry, The University of Newcastle, Newcastle upon Tyne, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Thomason
authors.forename: N M
authors.initials: NM
authors.lastname: Girdler
authors.forename: P
authors.initials: P
authors.lastname: Kendall-Taylor
authors.forename: H
authors.initials: H
authors.lastname: Wastell
authors.forename: A
authors.initials: A
authors.lastname: Weddel
authors.forename: R A
authors.initials: RA
authors.lastname: Seymour
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D018592:Cross-Over Studies; D017742:Dental Care for Chronically Ill; D004311:Double-Blind Method; D005260:Female; D019214:Gingival Overgrowth / Q000139:chemically induced / Q000601:surgery; D005890:Gingivectomy; D016027:Heart Transplantation; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007275:Injections, Intravenous; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D016377:Organ Transplantation; D011300:Preoperative Care
chemical_list: D007166:Immunosuppressive Agents; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone