Increased infection risk postliver transplant without pretransplant dental treatment

Authors

  • J Helenius-Hietala,

    Corresponding author
    1. Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland
    • Department of Oral Infectious Diseases, Institute of Dentistry, University of Helsinki, Helsinki, Finland
    Search for more papers by this author
  • F Åberg,

    1. Transplantation and Liver Surgery Clinic, Helsinki University Central Hospital, Helsinki, Finland
    Search for more papers by this author
  • JH Meurman,

    1. Department of Oral Infectious Diseases, Institute of Dentistry, University of Helsinki, Helsinki, Finland
    2. Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland
    Search for more papers by this author
  • H Isoniemi

    1. Transplantation and Liver Surgery Clinic, Helsinki University Central Hospital, Helsinki, Finland
    Search for more papers by this author

Correspondence: Dr. Jaana Helenius-Hietala, Department of Oral Infectious Diseases, Institute of Dentistry, University of Helsinki, PO Box 41, Helsinki FI-00014, Finland. Tel: +358 40 724 7275, Fax: +358 9 191 27286, E-mail: jaana.s.helenius@helsinki.fi

Abstract

Objective

Infections cause considerable morbidity after liver transplantation (LT). Acute liver failure is a rapidly progressing life-threatening condition where pretransplant dental evaluation is not always possible. We investigated how missing pretransplant dental treatment in acute or subacute liver failure correlates with post-transplant infectious complications.

Subjects and methods

Medical and dental data came from hospital records and infection data from the Finnish LT registry. The follow-up was until February 2011. Of 51 patients (LT during 2000–2006), 16 had and 35 did not have dental treatment pretransplant.

Results

Univariate Cox regression analysis demonstrated a 2.46-fold (95% CI 1.06–5.69) infection risk among the patients omitted from dental treatment. After adjustment for either pretransplant factors alone or both pre- and post-transplant factors, the corresponding infection risk increased, respectively, to 8.17-fold (95% CI 2.19–30.6) and 8.54-fold (95% CI 1.82–40.1). This increased risk involved a variety of bacterial, viral, and fungal infections of various sources both < 6 and > 6 months after transplantation.

Conclusion

High risk of infections was noticed in acute liver failure patients without pretransplant dental treatment, but a more severe medical condition might have influenced the results. We encourage eradication of dental infection foci whenever clinical condition allows.

Ancillary