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Moura AEO, Besseler MO, Pérez-de-Oliveira ME, Normando AGC, Neves ILI, Neves RS, Vargas PA, Azeka E, Santos-Silva AR, Montano TCP. Prevalence and clinical characteristics of oral lesions in heart transplant patients induced by sirolimus and everolimus: a systematic review and meta-analysis on a global scale. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:37-52. [PMID: 37925270 DOI: 10.1016/j.oooo.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE Sirolimus (SRL) and everolimus (EVL) are increasingly included in immunosuppressive protocols after heart transplantation. They present some side effects, including the appearance of painful lesions in the oral cavity. Therefore, this systematic review aimed to verify the global prevalence and clinical characteristics of oral lesions induced by SRL and EVL in heart transplant patients. STUDY DESIGN A systematic review was performed using 5 main electronic databases (Medline/PubMed, SCOPUS, EMBASE, Web of Science, and LILACS), in addition to the gray literature. Studies were independently assessed by 2 reviewers based on established eligibility criteria. The risk of bias was assessed using the Joanna Briggs Institute appraisal tools, and the certainty of evidence was evaluated through GRADE assessment. RESULTS Seventeen studies (860 patients) were included in the qualitative analysis. Of these, 11 studies were pooled in a meta-analysis of prevalence. The worldwide prevalence of oral lesions induced by SRL and EVL in heart transplant patients was 10.0%, and most lesions were described as ulcers >1.0 cm, related to significant pain. CONCLUSIONS Oral lesions induced by SRL and/or EVL, although not very prevalent, have a relevant impact on patient's lives and the continuity of treatment.
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Affiliation(s)
- Anne Evelyn Oliveira Moura
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| | - Mariana Oliveira Besseler
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Maria Eduarda Pérez-de-Oliveira
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Ana Gabriela Costa Normando
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Itamara Lucia Itagiba Neves
- Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas, Medical School, University of São Paulo (HCFMUSP), São Paulo, Brazil
| | - Ricardo Simões Neves
- Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas, Medical School, University of São Paulo (HCFMUSP), São Paulo, Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Estela Azeka
- Pediatric Cardiology Unit, Instituto do Coração (InCor), Hospital das Clínicas, Medical School, University of São Paulo (HCFMUSP), São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Tânia Cristina Pedroso Montano
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas, Medical School, University of São Paulo (HCFMUSP), São Paulo, Brazil
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Rosenthal LL, Ulrich SM, Zimmerling L, Brenner P, Müller C, Michel S, Hörer J, Netz H, Haas NA, Hagl C. Pediatric heart transplantation in infants and small children under 3 years of age: Single center experience - "Early and long-term results". Int J Cardiol 2022; 356:45-50. [PMID: 35395286 DOI: 10.1016/j.ijcard.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/01/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We analyzed the early and long-term survival after ABO-compatible heart transplantation in children under 3 years of age from 1991 to 2021 at our center. This retrospective and descriptive study aimed to identify serious adverse events associated with mortality after pediatric heart transplantation. PATIENTS AND METHODS 46 patients with congenital heart failure (37%) in end-stage heart failure have undergone a pediatric heart transplantation. Primary outcome of interest was survival at follow-up time. RESULTS Median (IQR) follow-up time (y), age (y), body-weight (kg) and BMI (kg/cm2) were 13.2 (5.7-19.5), 0.9 (0.2-2.0), 6.8 (4.3-10.0) and 14.2 (12.3-15.7). Twenty-four (52%) patients were male. 15 patients (33%) had a single ventricle physiology. At 30- days survival rate was 94 ± 4%. Survival rate at 1, 5, 10 and 15 years post HTx was 87 ± 5%, 84 ± 6%, 79 ± 6% and 63 ± 8%. One child underwent re-transplantation after 4 years, and another one after 11 years - in both cases due to graft failure. Higher early mortality in patients under 3 months of age and in patients with single ventricle physiology. Transplant free survival at 15 years was in children with cardiomyopathy better (71 ± 10%) than in those with congenital heart disease (50 ± 13%). One or more previous heart surgeries prior to HTx (n = 21) were associated to more mortality. CONCLUSION Pediatric heart transplantation has acceptable long-term results and is still the best therapeutic option in children with end-stage cardiac failure. Underlying anomalies and single ventricle physiology, age below 3 months had a significant impact on survival.
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Affiliation(s)
- L Lily Rosenthal
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany; Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Sarah Marie Ulrich
- Division of Pediatric Cardiology and Intesive Care, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Linda Zimmerling
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany; Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany
| | - Paolo Brenner
- Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Christoph Müller
- Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Sebastian Michel
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany; Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Jürgen Hörer
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Heinrich Netz
- Division of Pediatric Cardiology and Intesive Care, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Nikolaus A Haas
- Division of Pediatric Cardiology and Intesive Care, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Christian Hagl
- Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany; Munich Heart Alliance (MHA) - DZHK, Ludwig Maximilians University Munich, Department for Epidemiology and Prevention of Cardiovascular Diseases, Pettenkoferstr. 8a & 9, D- 80336 Munich, Germany.
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