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Oral diseases after liver transplantation: a systematic review and meta-analysis

British Dental Journal volume 231, pages 117–124 (2021)Cite this article

Abstract

Objective To conduct a systematic review and meta-analysis to evaluate the impact of liver transplantation on the occurrence and frequency of oral diseases in humans.

Data sources The study query was performed on Medline/PubMed, Ovid, Cochrane Library and Embase databases, including the grey literature.

Data selection Observational studies comparing the frequency of oral manifestations in post-liver transplantation patients versus reference population were eligible for inclusion.

Data extraction and analysis The article selection, data extraction and quality assessment were executed by three independent investigators. A random-effects meta-analysis was carried out for computation of relative risks of oral malignancies (standardised incidence ratio [SIR] and 95% confidence interval [CI]).

Data synthesis Among 248 studies identified, 11 met the eligibility criteria and six were included in the meta-analysis. Opportunistic fungal infections (Candida spp.) and lesions with malignant potential were reported to be more frequently prevalent after liver transplantation. Calculations indicated that after liver transplantation, the patients have a fivefold increased risk for oral cancer occurrence compared to the general population (SIR = 5.006; 95% CI 2.803 to 8.94; p <0.001).

Conclusions The findings suggest that liver transplantation increases the risk of oral malignancies and the frequency of other mucosal lesions.

Key points

  • A systematic review identified 11 studies comparing the frequency of oral mucosal diseases of liver-transplanted patients with healthy subjects/general population/pre-liver transplantation patients.

  • Some oral mucosal lesions, including entities with malignant potential, were found to be more common in liver transplant recipients than in the reference population.

  • Oral opportunistic infections were more frequent in patients undergoing liver transplantation and rare pathogens were found to colonise their oral cavity.

  • Meta-analysis showed that the risk of developing oral cancer was increased fivefold as compared to the general population.

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Acknowledgements

Andreea Cristiana Didilescu and Raluca-Paula Vacaru contributed equally to this paper.

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Authors and Affiliations

  1. Department of Embryology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    Andreea Cristiana Didilescu, Raluca-Paula Vacaru & Adelina Lazu

  2. Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands

    Corien Pronk & Hendrik Simon Brand

  3. Department of Physiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    Cristian Scheau

  4. Department of Liver Transplant, St Mary´s Clinical Hospital, Bucharest, Romania

    Laura Popa Dan

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Correspondence to Andreea Cristiana Didilescu.

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Didilescu, A., Vacaru, RP., Pronk, C. et al. Oral diseases after liver transplantation: a systematic review and meta-analysis. Br Dent J 231, 117–124 (2021). https://doi.org/10.1038/s41415-021-3219-1

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