ORGAN AND BMT

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CHAPTER 21 Organ and Bone Marrow Transplantation

Transcript of ORGAN AND BMT

CHAPTER 21Organ and Bone Marrow

Transplantation

Complications• Complications associated

with organ transplantation generally consist of :

1. technical problems involving the surgical procedure

2. problems related to immunosuppression

3. special problems specific to the organ transplanted

Immunosuppression• Excessive immunosuppression increases the risk for infection and must

be avoided.• signs :Infectionsdelayed healingHypertensionDiabetes Addison’s disease-type reactions cushingoid features (e.g., edema, ascites, buffalo hump, moonfacies) increased susceptibility to infectionWeaknessfatigue

Rejection• Rejection ---« signs and symptoms of

organ failure.• Organ biopsy is used to confirm the

rejection reaction (Figure 21-9). • evidence of acute rejection -----« increase

dosage of the immunosuppressive agents.• Chronic rejection occurs insidiously and

is progressive.• It cannot be reversed with intensified

therapy.• Chronic rejection ----« organ failure.• Classic evidence of chronic rejection is

found by biopsy.

Drug Side Effects• A major side effect of azathioprine is bone marrow suppression with resulting leukopenia, thrombocytopenia, and anemia. • These changes greater risk for infection and excessive bleeding. • Cyclosporine has replaced azathioprine.• Cyclosporine side effects : severe kidney and liver changes hypertension- bleeding –anemia

potentiate renal injury caused by other agents. gingival hyperplasia hirsutismGynecomastiacancers of the skin and cervix

• Antithymocyte globulin (ATG) and ALG both act as lymphocyte-selective immunosuppressants.• side effects : feverHemolysisLeukopeniaThrombocytopeniatumor developmentincreased risk for infection

Prednisone side effects :hypertensiondiabetes mellitusOsteoporosisimpaired healingmental depressionPsychosesincreased risk for infection adrenal gland suppression.

cancers• Immunosuppressed patients exhibit an increased incidence of certain cancers.• 6% various forms of cancer.• Cancers commonly seen in the general population (carcinomas of lung, breast, prostate, and colon) show no change in occurrence in immunosuppressed patients.• two types of cancer found commonly increased frequency :squamous cell carcinoma of the skincarcinomas of the uterine cervix

• Cancers that are uncommon in the general population but that occur with increased frequency in immunosuppressed patients are

Lymphomaslip carcinomasKaposi sarcomacarcinomas of the kidney carcinomas of the vulva

and perineum

Special Organ Complications• involve: heart bone marrowGVHD is an important and often lethal

complication of allogenic BMT Acute GVHD : first 3 months after

transplantation mucosal, skin, liver,

gastrointestinal tract involvementIntraorally there are nonspecific

mucosal ulcers and palatal mucoceles. (Figures 21-10 to 21-12).

• Chronic GVHD :occurs later (often after day 100) characterized by skin changes similar to those in scleroderma, sicca syndrome, malabsorption, and features of autoimmunity.

DENTAL MANAGEMENT• Pretransplant Medical Considerations :

Posttransplantation Medical Considerations:

(1) immediate posttransplantation period:

first 3 months afterimmunosuppressive

therapy(2) stable

posttransplantation period (3) chronic rejection

period.

(2) stable posttransplantation period

TREATMENT PLANNING CONSIDERATIONS• Pre transplantation

Patients

Post transplant Patients

Immediate Post transplantation Period.Stable Post transplantation Period .Risk of Infection.Viral Infections.Excessive Bleeding.Adverse Reaction to Stress.Hypertension.Chronic Rejection Period.

Oral Complications and Manifestations• Oral findings that may indicate

over immunosuppression include :

Mucositisherpes simplex infectionsherpes zosterCMV infectionCandidiasislarge and slow-to- heal

aphthous ulcers and other ulcerations

unusual alveolar bone loss on occasionLymphomaKaposi sarcomasquamous cell carcinoma of

the liphairy leukoplakia.