Impact of Oral Infection on Organ Transplantation: A Systematic Review

Abstract

Objectives: Posttransplant infections may lead to dire consequences in immunocompromised organ recipients. Oral foci of infection are therefore often eliminated prior to solid organ transplantation to reduce posttransplant morbidity. However, despite increasing numbers of organ transplantations the necessity of pretransplant dental treatment and its effect on transplant outcome remains uncertain. The aim of the present systematic review was to evaluate the impact of oral foci of infection and pretransplant dental treatment on adverse events following solid organ transplantation.

Methods: Studies on adult patients undergoing solid organ transplantation with/without oral infection or with/without pretransplant dental treatment were eligible. An electronic search in PubMed, Scopus, Web of Science, CINAHL and Cochrane was conducted up to June 11, 2024. Screening of eligibility, data extraction and risk-of-bias assessment of the included studies with the Newcastle-Ottawa Scale were done independently by two reviewers. Data were synthesized with a narrative approach.

Results: In total, 4035 unique publications were identified. After full text assessment of 75 studies nine cohort studies on liver, kidney, heart and/or lung transplantation based on 727 patients were included. Two studies based on 161 patients found a significant increase of infectious complications after liver transplantation when no dental treatment was performed. Presence of oral foci increased the risk of hospitalization after kidney transplantation in one study but was associated with lower infection rate after lung transplantation in another study. No studies found significant impact on mortality or on organ rejection. Overall, the quality of the included studies was good with low or medium risk-of-bias.

Conclusion: To our knowledge, this is the first systematic review on the impact of oral infection on organ transplantation. The results suggest a possible link between persisting oral infection and posttransplant infectious complications, thus lending support to the elimination of oral infectious foci before solid organ transplantation.

Keywords: dental focal infection; dentistry; heart transplantation; kidney transplantation; liver transplantation; lung transplantation.