Gingival status of Brazilian renal transplant recipients under sirolimus-based regimens.
BACKGROUND
Although the prevalence of gingival overgrowth (GO) in calcineurin-inhibitor (CNI) immunosuppressive regimens has been well documented, to the best of our knowledge data from sirolimus (SIR) regimens have not been described. We sought to investigate the gingival status of renal transplant recipients under SIR-based regimens with regard to the prevalence and potential risk variables associated with GO.


METHODS
A cross-sectional study was conducted at a public hospital in Belo Horizonte, MG, Brazil. Of 886 transplant recipients, an eligible sample of 144 subjects was selected. Medical, pharmacologic, and periodontal variables were recorded for each subject. GO was assessed through visual inspection and was evaluated in relation to variables of interest by univariate and multivariate analyses.


RESULTS
Although not clinically significant, 20.8% of the samples had GO, with a mean GO score of 5.0% +/- 3.98% (range, 0% to 19%) and mean GO score per papilla of 0.378 +/- 0.361 (range, 0.1 to 1.9); the percentage of papilla affected by GO was 14.35% +/- 9.86% (range, 5% to 45%). The multivariate final model, excluding periodontal variables, showed that the concomitant use of calcium channel blockers (P = 0.033) and the interaction between time since transplant and previous CNI use (P <0.001) were associated with GO. Adding periodontal variables to the model improved its accuracy and retained papillary bleeding index as being strongly associated with GO (P <0.001).


CONCLUSIONS
GO was observed in a considerable number of subjects under SIR-based immunosuppressive regimens, although the relationship was not clinically significant. Findings point to the importance of cooperation between medical and dental health care personnel in the maintenance of renal transplant recipients under SIR-based immunosuppressive regimens.
Cota
Luís Otávio Miranda
LO
Department of Periodontology, Federal University of Minas Gerais, Belo Horizonte, Brazil. focperio@uol.com.br
Oliveira
Ana Paula Lima
AP
Costa
José Eustáquio
JE
Cortelli
Sheila Cavalca
SC
Costa
Fernando Oliveira
FO
D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D002121:Calcium Channel Blockers / Q000009:adverse effects; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D017742:Dental Care for Chronically Ill; D005260:Female; D019214:Gingival Overgrowth / Q000139:chemically induced* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010512:Periodontal Index; D012720:Severity of Illness Index; D020123:Sirolimus / Q000009:adverse effects*; D055815:Young Adult
D002121:Calcium Channel Blockers; D007166:Immunosuppressive Agents; D020123:Sirolimus