An investigation into the need for supplementary steroids in organ transplant patients undergoing gingival surgery - A double-blind, split-mouth, cross-over study

Organ transplant patients are frequently medicated with triple immunosuppre ssive therapy that includes both cyclosporin and the corticosteroid, predni solone. Many of these patients experience gingival overgrowth that necessit ates surgical intervention. Chronic dosing with corticosteroids can lead to suppression of the hypothalamic-pituitary axis, and subsequent adrenocorti cal suppression. To circumvent possible suppression, supplementary steroids are administered to such patients prior to so-called "stressful events". W e have examined the need for supplementary steroids in 20 organ transplant patients undergoing gingival surgery under local anaesthesia to correct the ir drug-induced gingival overgrowth. All patients were operated upon in the first half of the morning. Prior to gingival surgery, resting blood pressu re (BP) and serum ACTH concentrations were determined. Immediately before s urgery patients received either intravenous hydrocortisone 100 mg or placeb o in random, double-blind order. Each patient required 2 gingivectomies and thus acted as their own placebo control. BP was measured at various time p oints throughout surgery and upto 2 h postoperatively. On completion of sur gery, a further blood sample was taken to determine ACTH concentration. The re was no significant difference (p>0.05) between placebo and hydrocortison e treatments for BP and ACTH measurements. No patient experienced any sympt oms that were suggestive of adrenocortical suppression. One patient did exp erience postural hypotension prior to gingival surgery, but this is attribu ted to his antidepressant medication. We can conclude from this study that immunosuppressed organ transplant patients taking the maintenance dose of p rednisolone (5-10 mg/day) do not require corticosteroid cover prior to ging ival surgery under local anaesthesia. We would however, advocate monitoring of their blood pressure throughout the procedure.