Evaluation of the correlation between oral infections and systemic complications in kidney transplant patients: a retrospective pilot study

Impact of Oral Infection on Organ Transplantation: A Systematic Review

OBJECTIVES

Posttransplant infections may lead to dire consequences in immunocompromised organ recipients. Oral foci of infection are therefore often eliminated prior to solid organ transplantation to reduce posttransplant morbidity. However, despite increasing numbers of organ transplantations the necessity of pretransplant dental treatment and its effect on transplant outcome remains uncertain. The aim of the present systematic review was to evaluate the impact of oral foci of infection and pretransplant dental treatment on adverse events following solid organ transplantation.

METHODS

Studies on adult patients undergoing solid organ transplantation with/without oral infection or with/without pretransplant dental treatment were eligible. An electronic search in PubMed, Scopus, Web of Science, CINAHL and Cochrane was conducted up to June 11, 2024. Screening of eligibility, data extraction and risk-of-bias assessment of the included studies with the Newcastle-Ottawa Scale were done independently by two reviewers. Data were synthesized with a narrative approach.

RESULTS

In total, 4035 unique publications were identified. After full text assessment of 75 studies nine cohort studies on liver, kidney, heart and/or lung transplantation based on 727 patients were included. Two studies based on 161 patients found a significant increase of infectious complications after liver transplantation when no dental treatment was performed. Presence of oral foci increased the risk of hospitalization after kidney transplantation in one study but was associated with lower infection rate after lung transplantation in another study. No studies found significant impact on mortality or on organ rejection. Overall, the quality of the included studies was good with low or medium risk-of-bias.

CONCLUSION

To our knowledge, this is the first systematic review on the impact of oral infection on organ transplantation. The results suggest a possible link between persisting oral infection and posttransplant infectious complications, thus lending support to the elimination of oral infectious foci before solid organ transplantation.

Hyaluronic Acid Treatment of Post-Extraction Tooth Socket Healing in Subjects with Diabetes Mellitus Type 2: A Randomized Split-Mouth Controlled Study

The present study aimed to investigate the effect of HA in improving post-extraction socket healing in subjects with diabetes mellitus (DM) type 2. DM patients requiring bilateral extraction of the homologous teeth were visited at the C.I.R. Dental School, University of Turin. After the extractions, one site was randomly assigned to the test (T) group (postoperative application of HA), while the other site was assigned to the control group (C, no treatment). Patients were then followed after 3, 7, 14, and 21 days. Primary outcomes were the healing index and socket closure. The Mann-Whitney test or the Student's t-test was used for nonparametric or parametric distributed variables. The chi-square test was used if the estimated data in any given cell were >5, otherwise the Fisher test was adopted. A p < 0.05 was considered statistically significant. In total, 36 patients (n = 36) were enrolled in this study for a total of 72 extractions (n = 72). Sockets treated with HA showed significantly (p < 0.05) better healing index values at day 7 (p = 0.01) and at day 14 (p = 0.02) and significantly (p < 0.05) better socket closure values at day 3 (p = 0.04), day 7 (p = 0.001) and day 14 (p = 0.001) compared to the C group. Based on the clinical results, HA seems to be promising in improving the timing and the quality of post-extractive wound healing in DM patients. Further clinical research, as well as histological investigations, are required to confirm the results.