Drug-induced gingival overgrowth in renal transplants patients

TL;DR

This review discusses how certain drugs used in kidney transplants can cause gum overgrowth, and suggests alternatives and management strategies.

Contribution

The paper provides a comprehensive review of drug-induced gingival overgrowth in renal transplant patients and evaluates the comparative risks of different immunosuppressive agents.

Findings

Cyclosporine A is strongly associated with drug-induced gingival overgrowth.

Tacrolimus has a lower incidence of causing gingival overgrowth compared to Cyclosporine A.

Mycophenolate mofetil can worsen gingival changes when combined with other immunosuppressants.

Abstract

This narrative review describes the scientific evidence on drug-induced gingival overgrowth (DIGO) in kidney transplant patients treated with immunosuppressive agents, particularly Cyclosporine A, focusing on its prevalence, pathogenetic mechanisms, and clinical management strategies.

This study was conducted including PubMed, Scopus, and Web of Science, highlighting clinical studies and case reports.

DIGO is an oral complication in transplant patients treated with cyclosporine A, and its frequency may increase when combined with calcium channel blockers. However, tacrolimus has shown a lower incidence of DIGO compared with Cyclosporine A, making it a favorable therapeutic alternative in immunosuppressive regimens for renal transplant patients. Mycophenolate mofetil, despite being less directly linked to DIGO, can exacerbate gingival changes when combined with other immunosuppressants by promoting inflammation and connective tissue remodeling. Sirolimus is associated with a lower risk of DIGO compared with calcineurin inhibitors; however, some isolated cases have been reported, particularly in patients previously exposed to Cyclosporine A or when used in combination with calcium channel blockers. Management strategies include proper oral hygiene, dose adjustment or medication substitution, and, in some cases surgical intervention.

The fundamental keys to reducing its incidence and severity are a personalized immunosuppressive regimen with a multidisciplinary approach.

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