chapter 21

1. CHAPTER 21
Organ and Bone Marrow Transplantation

2. Complications
• Complications associated with organ
transplantation generally consist of :
1. technical problems involving the surgical
procedure
2. problems related to immunosuppression
3. special problems specific to the organ
transplanted

3. Immunosuppression
• Excessive immunosuppression increases the risk for infection and must be avoided.
• signs :
Infections
delayed healing
Hypertension
Diabetes
 Addison’s disease-type reactions
 cushingoid features (e.g., edema, ascites, buffalo hump, moonfacies)
 increased susceptibility to infection
Weakness
fatigue

4. Rejection
• Rejection ---« signs and symptoms of organ failure.
• Organ biopsy is used to confirm the rejection reaction (Figure
21-9).
• evidence of acute rejection -----« increase dosage of the
immunosuppressive agents.
• Chronic rejection occurs insidiously and is progressive.
• It cannot be reversed with intensified therapy.
• Chronic rejection ----« organ failure.
• Classic evidence of chronic rejection is found by biopsy.

5. Drug Side Effects
• A major side effect of azathioprine is bone marrow suppression with resulting leukopenia,
thrombocytopenia, and anemia.
• These changes greater risk for infection and excessive bleeding.
• Cyclosporine has replaced azathioprine.
• Cyclosporine side effects:
 severe kidney and liver changes hypertension- bleeding –anemia
 potentiate renal injury caused by other agents.
 gingival hyperplasia
 hirsutism
Gynecomastia
cancers of the skin and cervix

6. • Antithymocyte globulin (ATG) and ALG both act as lymphocyte-selective immunosuppressants.
• side effects :
 fever
Hemolysis
Leukopenia
Thrombocytopenia
tumor development
increased risk for infection

7. Prednisone side effects :
hypertension
diabetes mellitus
Osteoporosis
impaired healing
mental depression
Psychoses
increased risk for infection
 adrenal gland suppression.

8. cancers
• Immunosuppressed patients exhibit an increased incidence of certain cancers.
• 6% various forms of cancer.
• Cancers commonly seen in the general population (carcinomas of lung, breast, prostate,
and colon) show no change in occurrence in immunosuppressed patients.
• two types of cancer found commonly increased frequency :
squamous cell carcinoma of the skin
carcinomas of the uterine cervix

9. • Cancers that are uncommon in the general
population but that occur with increased
frequency in immunosuppressed patients are
Lymphomas
lip carcinomas
Kaposi sarcoma
carcinomas of the kidney
 carcinomas of the vulva and perineum

10. Special Organ Complications
• involve:
 heart
 bone marrow
GVHD is an important and often lethal complication
of allogenic BMT
 Acute GVHD :
 first 3 months after transplantation
mucosal, skin, liver, gastrointestinal tract involvement
Intraorally there are nonspecific mucosal ulcers and
palatal mucoceles. (Figures 21-10 to 21-12).

11. • Chronic GVHD :
occurs later (often after day 100)
 characterized by skin changes similar to those in scleroderma, sicca syndrome, malabsorption, and
features of autoimmunity.

12. DENTAL MANAGEMENT
• Pretransplant Medical Considerations :

13. Posttransplantation Medical Considerations:
(1) immediate posttransplantation period:
first 3 months after
immunosuppressive therapy
(2) stable posttransplantation period
 (3) chronic rejection period.

14. (2) stable posttransplantation period

15. TREATMENT PLANNING CONSIDERATIONS
• Pre transplantation Patients

16. Post transplant Patients
Immediate Post transplantation Period.
Stable Post transplantation Period.
Risk of Infection.
Viral Infections.
Excessive Bleeding.
Adverse Reaction to Stress.
Hypertension.
Chronic Rejection Period.

17. Oral Complications and Manifestations
• Oral findings that may indicate over
immunosuppression include :
Mucositis
herpes simplex infections
herpes zoster
CMV infection
Candidiasis
large and slow-to- heal aphthous ulcers and other
ulcerations
unusual alveolar bone loss
 on occasion
Lymphoma
Kaposi sarcoma
squamous cell carcinoma of the lip
hairy leukoplakia.