# Association Between Solid Organ Transplantation and Oral Candidiasis: A Systematic Review and Meta‐Analysis

## TL;DR

This study finds that solid organ transplant recipients have a higher risk of oral candidiasis compared to healthy controls.

## Contribution

The study provides a meta-analysis of the association between solid organ transplantation and oral candidiasis.

## Key findings

- The pooled odds ratio for candidiasis in transplant recipients was 3.52 compared to controls.
- Heart transplant recipients had the highest odds ratio of 152.01 for oral candidiasis.
- Evidence certainty was moderate, suggesting a need for more research on pancreas and small bowel transplants.

## Abstract

To summarize the evidence on the association of oral candidiasis with solid organ transplantation in case‐control and cohort studies.

The quality of studies was assessed using the Newcastle–Ottawa scale. Random‐effects restricted maximum likelihood model or Fixed‐effects Mantel–Haenszel models were used to pool the results appropriately, and sensitivity analysis, subgroup analysis, and publication bias were assessed. The certainty of evidence was assessed using the GRADE approach.

The pooled OR of candidiasis in immunosuppressed individuals receiving solid organ transplants compared to controls was found to be 3.52 (95% CI: 1.92, 6.46; p < 0.05). The pooled OR of oral candidiasis in kidney transplant recipients compared to controls was 3.53 (95% CI: 1.92, 6.49; p < 0.05); for liver, 20.12 (95% CI: 3.83, 105.74; p < 0 .05), and heart, 152.01 (95% CI: 17.71, 1304.96; p < 0.05).

There was moderate certainty of evidence that there was an increased risk of oral candidiasis in immunosuppressed patients who received solid organ transplants compared to healthy controls. Similarly, the evidence was moderate for subgroup analysis regarding the kidney transplant recipients, liver transplant recipients, and heart transplant recipients. Due to the lack of current research, future research should evaluate the risk of oral candidiasis in patients receiving pancreas or small bowel transplants. Also, future studies should evaluate the role of prophylactic antifungals in immunosuppressed solid organ transplant recipients.

PROSPERO number: CRD42022363816.