1. Organ Transplants

2. Transplant Challenges
In the U.S. there are over 119,000 people on the waiting list for organ transplant as of December, So far 27,605 people have received organ transplants (OPTN, 2016). There are many different types of transplants a patient might undergo for various health reasons. What they all have in common is the general risk of rejection by the host. This is caused mostly by our body’s natural immune system.
An individual’s T-cells recognize foreign cells and activate an immune response. Some of these T-cells “differentiate into memory cells, which provide rapid recall responses to antigen re-challenge.” This means that without a way to suppress this action, the host will continuously form antibodies to fight against the transplanted cells, or in this case organs. (Nappalli & Lingappa, 2015)
Transplant Challenges

3. Medication considerations
Transplant patient have to take immunosuppressive medications for the rest of their lives.
Anti-rejection medications, prescribed after implant surgery, may lead to oral yeast infections, herpes and various aggressive types of bacteria in the mouth. These medications may also cause xerostomia, and generally make the transplant patient more prone to communicable diseases.
Medication considerations

4. Heart Transplant
During heart transplantation, the patient’s diseased or dysfunctional heart is replaced by a healthy donor heart. When a donor heart is placed into the patients body the WBCs will try to attack and destroy it (acute rejection). Patients will take anti- rejection medications for the rest of their lives to prevent the rejection. Chronic rejection may take place more than one year after the transplant surgery so the transplant patient must eat a low-fat diet, exercise and take the prescribed anti-rejection medication.

5. Kidney transplants are one of the most common transplant operations in the United States.
When a patient reaches stage five kidney failure is when the process begins for finding a donor and being tested to see if one is eligible for a kidney transplant.
Before someone receives a kidney transplant they will be evaluated at the transplant center, to make sure that you are a good candidate.
Tissue and blood typing will be done to make sure your body will not reject the donated kidney.
You will then be put on a kidney transplant waiting list, the factor in how soon you get a kidney is based on they type of kidney problems you have, how sever your heart disease is, and the likelihood that the transplant will be successful.
Kidney Transplant

6. Treatment considerations for Kidney Transplant
The ideal treatment plan should restore the patient to optimal oral health before the surgery and therefore may necessarily need to be quick because the transplant surgery may be forthcoming
Not eligible to transplant if you have TB, smoke, drink, have a healthy lifestyle problems taking medications each day for the rest of your life, heart, lung, or liver disease, recent history of cancer, or hepatitis.
Best to avoid any dental treatment for 6 months after transplant
Pre-med will be needed at these dental appointments
Treatment considerations for Kidney Transplant

7. If your liver has been severely damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors who donate a portion of their livers.
For people with hepatitis C infection, a liver transplant is not a cure. Treatment with antiviral medications usually continues after a liver transplant, since hepatitis C infection is likely to recur in the new liver.
Liver transplant

8. Liver Transplant
It is common for the immune system to attack the new liver. This occurs in up to 40% of cases, typically in the first 7-14 days after the transplant.
Symptoms of liver rejection include:
a high temperature of 38ºC (100.4ºF) or above
vomiting
diarrhea
yellow skin and yellowing of the whites of the eyes (jaundice)
pale stools
dark urine
itchy skin
Most cases can be successfully managed by altering your dose of immunosuppressant.

9. Most people with severe, end-stage lung disease can be considered for a lung transplant.
The most common lung diseases for which people undergo lung transplant are:
Chronic obstructive pulmonary disease (emphysema and chronic bronchitis)
Idiopathic pulmonary fibrosis
Cystic fibrosis
Idiopathic pulmonary arterial hypertension
More than 80% of people survive at least one year after lung transplant. After three years, between 55% and 70% of those receiving lung transplants are alive. Age at the time of transplant is the most important factor influencing lung transplant survival.
Proper oral health care both prior to transplant and after can greatly reduce the risk of secondary infections, and organ rejection; and increase the quality of life for transplant patients.
Lung transplant

10. Graft-versus-host disease (GVHD) is a complication that can occur after certain stem cell or bone marrow transplants.
This does not occur when they are receiving their own cells.
Before a transplant, tissue and cells from possible donors are checked to see how closely they match the recipient. GVHD is less likely to occur, or symptoms will be milder, when the match is close. The chance of GVHD is:
Around 30% to 40% when the donor and recipient are related
Around 60% to 80% when the donor and recipient are not related
Graft vs. Host Disease

11. Graft vs. Host Disease Cont.
2 types of GVHD: acute and chronic. Symptoms in both acute and chronic GVHD range from mild to severe.
Acute symptoms: (within 6 months after transplant)
Abdominal pain or cramps, nausea, vomiting, and diarrhea
Jaundice (yellow coloring of the skin or eyes) or other liver problems
Skin rash, itching, redness on areas of the skin
Chronic symptoms: (within 3 months after transplant, and can last a lifetime)
Dry eyes or vision changes
Dry mouth, white patches inside the mouth, and sensitivity to spicy foods
Fatigue, muscle weakness, and chronic pain
Joint pain or stiffness
Skin rash with raised, discolored areas, as well as skin tightening or thickening
Shortness of breath due to lung damage
Vaginal dryness
Weight loss
Graft vs. Host Disease Cont.

12. Dental Considerations
Xerostomia
Increased risk of caries
Increase calculus deposits
Discomfort and changes in taste
Gingival enlargement
bone loss
discomfort
poor esthetics and self-image of patients
difficulty chewing, and even trouble speaking
(Proctor, Kumar, Stein, Moles, & Porter, 2005)
Developmental disturbances in transplant patients under 12 y/o.
decreased crown size
shortened and conical roots
microdontia, or complete agenesis
decreased size of jaw bones
Dental Considerations

13. Dental Considerations Cont.
The most frequently missing teeth:
second premolars (58%)
second molars (28%)
first premolars (10%)
maxillary lateral incisors (4%)
Tooth agenesis occurred in 62% of recipients.
 Root stunting was reported in 27% of patients
Patients aged 3-5 years presented with the most severe aberrations of the root/crown ratio (77%). 
(Nappalli, & Lingappa 2015).
Immunosuppression medications, can lead to gingivitis and periodontitis, causing bone loss as well as malodor, or a bad taste in the patient’s mouth. The lesions that are common from immune suppression treatments are also painful, and can be a likely cause of non-compliance in personal oral home care.
(Proctor, Kumar, Stein, Moles, & Porter, 2005).
Dental Considerations Cont.

14. Mrs. Koehl’s DDS --17YO son
19 min.
Heart transplant due to cardiomyopathy
Erin Roberts thought her world had ended when her brother Kellen died suddenly at 22. His organs were donated—and Connor Rabinowitz received his heart in a transplant. After Erin and Connor met, what unfolded was a love story that no one could have anticipated.
—My DDS had 3 sons and I had 4 sons. Connor is 3rd from the left.
Mrs. Koehl’s DDS --17YO son

15. References
 Belmont Publications, Inc. (2002). Oral Care Key to Successful Organ Transplants. Dimensions of Dental Hygiene. Retrieved September 17, 2014 from
 Conlin, K. (2008). Treating Patients with Implanted Heart Devices. Dimensions of Dental Hygiene, 6(1), 14-17
   Northwestern Medicine. (2014). Heart transplantation General Information, 1-2.
Little, J. (2012). Chapter10 Liver Disease. In <i>Little and Falace's dental management of the medically compromised patient</i> (8th ed.). St. Louis, Mo.: Mosby.
Nappalli, D. Lingappa, A. (2015). Oral manifestations in transplant patients. Dental Research Journal 12.3: Retrieved from herzing.lirn.net/docview/ /B9337ED00C1F409FPQ/2?accounti d=167104

16. References
Organ Procurement and Transplantation Network (OPTN) (2016). Health Resources and Services Administration (HRSA). Retrieved from
Proctor, R. Kumar, N. Stein, A. Moles, D. Porter, S. (2005). Oral and Dental Aspects of Chronic Renal Failure. Journal of Dental Research p Retrieved from herzing.lirn.net/docview/ /92EF71AF8EC7414CPQ/2?accountid=