Conversion from cyclosporin a to tacrolimus as a non-surgical alternative to reduce gingival enlargement: a preliminary case series



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Hernández Vallejo, Gonzalo and Arriba de la Fuente, Lorenzo de and Frías, María Cruz and Macorra García, José Carlos de la and Vicente, Juan Carlos de and Jiménez, Carlos and Andrés, Amado de and Moreno González, Enrique (2003) Conversion from cyclosporin a to tacrolimus as a non-surgical alternative to reduce gingival enlargement: a preliminary case series. Journal of periodontology, 74 (12). pp. 1816-1823. ISSN 0022-3492

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Background: Gingival enlargement (GE) is a frequent side effect that occurs in organ transplant recipients (OTR) after the administration of cyclosporin A (CsA). The availability of new drugs used to suppress graft rejection in OTR offers an opportunity to manage GE non-surgically. This preliminary case series aimed to analyze the effect of CsA withdrawal and its substitution by another immunosuppressant in OTR with sever GE.
Methods: Four organ transplants recipients who had recieved a liver or renal allograft were recruited for this study. All OTR had developed clinically severe CsA-induced GE. GE scores were assessed for each patient at baseline and at weeks 2, 4, 8, 12, 16 and 54 followng conversion to tacrolimus. Scaling and root planing were initially performed and repeated monthly during the fisrt 6 months. Careful polishing of the teeth was carried out once every 2 weeks until month 6 and then monthly until month 12. Hygiene instructions and reinforcement to optimize oral hygiene were maintained throughout the study.
Results: the four patients showed a rapid decrease in their gingival symptoms and in the size of the gingivae. This change was clinically evident 8 weeks after conversion to tacrolimus. One year later, all the patients experienced GE regression, although some anatomic irregularities persisted in the interdental papillaea of one of the patients. No adverse effects from tacrolimus were observed during the study except in one patient who presented headaches.
Conclusion: It seems that CsA withdrawal and its conversion to tacrolimus in organ transplant recipients who develop severe gingival enlargement, together with an extensive plaque control program, provide an effective means to control/eliminate gingival hyperplasia, with minimal risk of graft dysfunction.

Item Type:Article
Uncontrolled Keywords:Cyclosporin A/adverse effects, follow-up studies, gingival hyperplasia/etiology, gingival hperplasia/therapy, organ transplantation/complications, tacrolimus/therapeutic use.
Subjects:Medical sciences > Dentistry > Periodontics
ID Code:5034
Deposited On:23 Nov 2005
Last Modified:29 Nov 2018 11:23

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