Cariello - Transplants Flashcards
T/F - Infection is leading cause of death and/or transplant failure.
TRUE
When is a transplant pt any highest risk?
Very soon after transplant
What contributes to a net state of immunosuppression?
Immunosuppressive therapy
Mucocutaneous-barrier integrity
Neutropenia
Underlying diseases
Metabolic conditions
Infections
Nutritional status
HSCT phases of immunosuppression?
Induction/conditioning
Consolidation/intensification
Maintenance
GVHD tx
Autologous vs allogeneic?
Autologous
-Self to self
—Less immunosuppression
—Less chance to beat the disease
Allogeneic
-Other to self
—More immunosuppression
—More chance to beat the disease
Post HSCT phases?
I
-Day 0-30
—Prolonged neutropenia
—Damage to mucocutaneous barriers
II
-Day 31-100
—Impaired cell-mediated immunity
—GVHD
III
-Day 100+
—Depends on immunosuppression
What are common infectious complications?
Bacterial
Viral
Bacterial
- Bacteremias and abscesses
- C diff
- Typhlitis - neutropenic enterocolitis
- TB
Viral
- EBV, PTLD
- VZV
- BK - Hemorrhagic cystitis and interstitial nephritis
- JC virus
Common infections:
Fungal
Parasites
Fungal -Yeast —Candida, cryptococcus, pneumocystis -Mold —Aspergillus and mucor
What care should be done pre-transplant?
Pt education
Prophy/Cleaning
Treat all active disease
Remove all potential sources of acute or chronic infection
Remove all non-restorable teeth
Reinforce oral hygiene and home care
Perform necessary denture adjustments
Daily abx mouthwash
4 indications for tooth extraction.
Tooth mobility (Pocket of 5-6+ mm)
Teeth with endo-perio problem
Teeth with periapical lesions
Teeth with very deep or extensive caries
*Postpone implant placement
Pre-transplant care?
Consult with MD
Educate pt about hygiene
Dental prophy
Careful with drugs
T/F - If pt has severe leukopenia and thrombocytopenia, then they should avoid flossing.
TRUE
What happens with radiation/chemotherapy?
Decreased production of saliva
Xerostomia promotes dental caries and increases risk of tooth decay
Mouth ulcers
-Difficult chewing, speaking and swallowing
Major risk factor for bacteremia is with what bug?
Strep viridans
Infectious complications due to chemotherapy?
Bacterial
Fungal
Viral
Bacterial
- Dental abscess
- Bacteremia
Fungal
- Candidiasis
- Aspergillus
Viral
- HSV - More severe and slow healing
- VSV
- CMV
- HHV8
- EBV
- HPV
Mucositis is most common when?
Post-HSCT tx
5 degrees
Mucositis affects what surfaces?
Non-kera mucosal surfaces
- Ventral and lateral tongue
- Floor of mouth
- Soft palate
- Buccal mucosa
- Inner lips
Discomfort and risk of infection
T/F - 50% of pts that get an allogeneic transplant will get GVHD.
TRUE
Non-infectious complications of grafting?
Medications
GVHD (Mostly from allogeneic HSCT)
Xerostomia
Taste alterations
Hemorrhage
Osteonecrosis of the jaw
Manifestations of GVHD?
Xerostomia
Lichens
Popular lesions
Erythema
Tongue surface atrophy
Ulceration
Rash, jaundice, diarrhea, eyes, lungs
What improves outcomes with GVHD?
Reducing the oral microbial load w/ tx of pre-existing conditions
Gingival hyperplasia is due to what?
Cyclosporine
-Worse if combined with Ca-channel blockers
HLA-DR1 - Protective
HLA-DR2 and HLA-B37 - Increased risk
When does gingival hyperplasia develop?
1-3 months after starting drugs
Begins at papilla
Epi invaded by candida hyphae
Cauliflower appearance
What should be kept in mind with medications with gingival hyperplasia?
Renal fx
Cyclosporine
Avoid NSAIDS
Prolonged steroids
