Factors affecting cyclosporine-induced gingival overgrowth in pediatric renal transplant recipients.

Resident: Adam J. Bottrill
Date: 15JAN10
Region: Providence
Article title: Factors affecting cyclosporine-induced gingival overgrowth in pediatric renal transplant recipients.
Author(s): Karpinia, Katherine DMD et al.
Journal: Pediatric Dentistry
Page #s: pp. 450-455
Year: 1996
Major topic: Cyclosporine-induced gingival overgrowth
Minor topic(s): Pediatric renal transplant patients
Type of Article: Summary of research

Main Purpose: To study the occurrence of gingival overgrowth in children after kidney transplantation and to investigate the relationship of gingival overgrowth (GO) to medical and dental parameters.

Overview of method of research: 49 transplant patients taking cyclosporine were evaluated for a number of different characteristics.

Key points in the article discussion:

A. General
1. CsA is used with organ recipients to prevent graft rejection.
2. Taken via oral or IV.
3. absorbed by gut and metabolized by the liver enzymes of the cytochrome P450 system.
4. Blood CsA levels >200 ng/mL is associated with various side effects.
5. GO first reported in 1983.
6. Recently reported that adults with >400 ng/mL have significantly greater risk of GO.
7. Though much has been reported on adults with CsA associated GO, not much out there on children and adolescents.


























B. Hypothesis:
1. The immunosuppressant drug CsA, as used in pediatric renal transplant patients, contributes to the clinical manifestation of GO.
2. Specific aims:
a. document the presence of GO in children with kidney transplants via exam
b. associate documented GO with blood trough levels of CsA
c. document the gingival health status of subjects exhibiting GO, compared with subjects without GO
d. detect relationships between medication and GO

C. Method:
1. 1992-1993: 49 subjects from 5.9-18.6 y.o.
2. 19 received cadaveric kidneys and 30 had living relative donors
3. All subjects were allowed routine dental care.
4. Inclusion Criteria
a. Hx of kidney transplant
b. CsA immunosuppressive therapy
5. Exam
a. CsA levels
b. Plaque and calculus (present vs not present)
c. Gingival index (normal, mild, moderate, severe)
d. Gingival width
e. Probing depth
f. Gingival overgrowth (present or not, per tooth)

D. Results and Discussion
1. Overall, subjects’ OH was fair. No subject was completely plaque-free.
2. This study found that 77.5% of pediatric patients meeting inclusion criteria exhibited GO at exam.
3. All those on CsA >3mo showed GO
4. In contrast with recent reports, this study found the prevalence of GO in children larger than recently reported adult CsA-induced GO.
5. This papillary and marginal GO yielding firm, nodular, or granular growth has been found with CsA, phenytoin, sodium valproate, primidone, CCB’s nifedipine, verapamil, diltiaze and nitrendipine.
6. GO frequency was NOT significantly associated with plaque, gingival index, calculus OR CsA levels.
7. The single most critical factor in GO occurrence was increased TIME of CsA therapy.














Assessment of article: Keep in mind these results are based on very specific inclusion criteria. Shenanigans?... you decide.