Periodontal treatment considerations for cell transplant and organ transplant patients.

Organ replacement has been prevalent in the mythology of medicine and surgery for several hundred years. An Indian legend from the 12th century BC recounts the powers of the Hindu god, Shiva, who transplanted the head of an elephant to his child, Lord Ganesha, the god of wisdom and health (84). One of the major medical and scientific accomplishments in the latter half of the 20th century was the replacement of failing kidneys, livers, hearts or lungs through transplantation with a healthy organ (68). Over the last 30 years, this treatment modality has changed from being a last-ditch desperate effort to prolong life to being an option for treating and managing a variety of diseases and conditions (120). The improved prognosis following organ transplant is a result of superior methods of obtaining donor– patient tissue matches, proper methods of transportation, understanding the immune system, and the discovery of potent immunosuppressive drugs that could delay or prevent the rejection of the transplanted organs (63). Although transplantation is beneficial, it is not without a range of complications, beginning with lifethreatening infections and ending with graft rejection. All transplant patients are typically screened for adequate dental health before an elective organ transplant to eliminate or treat active sites of infection in the oral cavity (136). In all of these cases, careful dental protocols must be observed to provide safe and effective care for patients. There are several organs that it is currently possible to transplant. The most common of these are the kidney, liver, heart, lung and pancreas. The major limiting factor in organ transplantation is the availability of organs for transplant. In the U.S.A., data on patients waiting for transplants, organs donated, transplants performed and clinical outcomes has been maintained by the United Network for Organ Sharing. Since 1987, the United Network for Organ Sharing has compiled data on more than 300,000 transplant patients. According to the United Network for Organ Sharing, as of December 30th 2005, the waiting list for solid organ transplants was 97,117 and only approximately 25,000 organ transplants had been performed each year in the previous 2 years (148). Recently, an analysis on the life years that could be saved by a deceased organ donor was carried out and, based on the projected survival of the organ transplant recipients, it was estimated that an average of 30.8 additional years could be distributed over 2.9 organs transplanted successfully. It was also estimated that an additional 55.8 life years could be added from a single donor if all six organs were transplanted to different recipients successfully (132). There seems to be no racial disparity among African-Americans and Caucasians for successful outcomes in transplantation when compared for functional performance and quality of life (106). This article will briefly discuss the conditions leading to organ failure and the medical concerns in treating the end-stage organ failure patient. The immunobiology, pharmacology, oral considerations and dental management of the organ transplant recipient will be discussed in the following sections.