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Title: A clinical study of the oral condition of paediatric liver graft recipients
Author: Hosey, Marie Therese
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 1997
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Abstract:
The liver transplantation procedure was first carried out in 1967 and, since that time, survival rates have been steadily improving. The introduction of the split liver graft procedure has now made liver transplantation available to babies under 1 year of age for the first time. This study is the largest in the world into the oral condition of paediatric liver graft recipients, it was carried out between 1992 and 1996 and contains five separate prospective clinical investigations. It has already been reported that there is a high prevalence of intrinsic pigmentation, enamel hypoplasia, delayed eruption and cyclosporin-induced gingival overgrowth in children with liver grafts. However, the previous studies are few and the number of children in the samples were small. Therefore, the impact of both the increased availability of liver grafts to babies and the improved survival of liver graft recipients on the future paediatric dental need of these children is still to be fully ascertained. Paediatric liver graft recipients also have a high nutritional demand both before and after liver grafting but, in spite of this, they have been shown to 'catch-up' on their peers one year after liver grafting. The effect of malnutrition on the eruption of the primary dentition and whether the same 'catch-up' growth occurs has never been investigated. The bioavailability of cyclosporin is already highly variable, especially in liver graft recipients, and is likely to be further compromised in babies and infants who receive a split liver graft due to poorer absorption. The effect of age, age at the time of transplantation and duration of cyclosporin therapy not only on the prevalence and severity of gingival overgrowth but also on the erupting primary dentition also merits investigation. Organ transplant recipients also have a higher risk of cytomegalovirus infection than the general population. It has recently been suggested that there is a link between cytomegalovirus infection and cyclosporin-induced gingival overgrowth. However, this has never been the subject of a clinical investigation. In the first study, fifty-five paediatric liver graft recipients, who represented a cross- section of the children who attended the Liver unit at Birmingham Children's Hospital, were examined. Thirty-seven of the children were below 5 years of age. Forty-seven percent of the study group had intrinsic pigmentation but only 11% were found to have enamel hypoplasia. The prevalence of delayed eruption was found to be in excess of 40%. Fifty-five percent of the children had gingival overgrowth. There was a significant inverse relationship between the duration of cyclosporin therapy and the trough cyclosporin concentration but analysis of variance failed to show any association between the trough cyclosporin concentration and the severity of the gingival overgrowth. In the second study, thirty-seven children with liver grafts who had intrinsic pigmentation of the dental hard tissues were examined and the severity of the intrinsic green pigmentation measured using a specially developed colour scale. The primary molar teeth were the most severely discoloured but the results of this investigation also suggest that the permanent incisors and first permanent molars are also likely to be similarly, if less severely, affected. The clinical evidence suggested that the deposition of the green pigment was incremental in nature and occurred in the immediate postnatal period. The study also found that the severity of the pigmentation did not to improve with time. The third study was a controlled study that compared the effect of malnutrition, the underlying liver disease, and cyclosporin medication in the aetiology of delayed eruption of the primary dentition. This study confirmed that the prevalence of delayed eruption of the primary dentition in children with liver grafts was 43%, and 48% in those who also had malnutrition. Children with liver grafts had significantly fewer teeth than their age-matched controls with liver disease. There was a highly significant association between the trough cyclosporin concentration and the number of teeth in liver graft recipients who did not have malnutrition. The results showed that malnutrition alone was not a significant aetiological factor. This findings suggest that cyclosporin caused delayed emergence of the primary dentition when there had previously been delayed eruption due to severe liver disease. In the fourth study, ninety-seven paediatric liver graft recipients were examined and the study population was divided into groups according to age, then by age at transplantation and by duration of cyclosporin therapy. The results showed that the prevalence of cyclosporin-induced gingival overgrowth varied with the age of the study sample.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.D.S.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.788697  DOI: Not available
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