Periodontal changes in liver cirrhosis and post-transplantation patients. I: Clinical findings

Background: Cyclosporin A (CsA) is widely used to prevent liver transplanta tion failure. CsA-induced gingival overgrowth is a common side effect. Howe ver, the effect of cirrhotic liver disease, liver transplantation, and immu nosuppressive therapy on the periodontium is yet unclear. The aim of the pr esent cross-sectional study was to examine the effect of liver cirrhosis, t ransplantation, and immunosuppressive therapy on the periodontium. Methods: The experimental group (LC) consisted of 13 liver cirrhosis patien ts. A second experimental group (PT) included 24 patients, post-liver trans plantation, receiving immunosuppressive therapy. Seventeen healthy subjects formed a control group. The Ramfjord index teeth were recorded for plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment le vel (CAL), and gingival overgrowth (GO). Results: Mean PI and mean GI for the LC, PT, and C groups were not statisti cally different (P >0.05). Mean PD for the LC (3.32 +/- 0.24 mm) and PT gro up (3.41 +/- 0.13 mm) was significantly higher (P=0.0001, ANOVA) compared t o the C group (2.45 +/- 0.16 mm). Likewise, CAL for the LC (4.89 +/- 0.47 m m) and PT group (4.68 +/- 0.47 mm) was significantly higher (P=0.001, ANOVA ) than the C group (2.78 +/- 0.23 mm). Patients in the PT group exhibited t he greatest mean GO scores (0.88 +/- 0.09) compared to the LC group (0.37 /- 0.07) and the C group (0.09 +/- 0.02). All 3 groups were significantly d ifferent from each other (P= 0.0001) despite great variability within the g roups. GO in the CsA-treated patients (1.1 +/- 0.09) was significantly high er (P= 0.0001) than in those treated with tacrolimus (0.57 +/- 0.1). Conclusions: Liver cirrhosis patients demonstrated greater pocketing and at tachment loss compared to healthy matched controls. These same differences were observed in patients post-transplantation. Gingival overgrowth occurre d as a result of the immunosuppressive therapy with CsA, while to a lesser degree with tacrolimus. Replacement of CsA by tacrolimus in patients manife sting gingival overgrowth might be recommended whenever possible to overcom e this problem.