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M Radwan-Oczko, M Boratyńska, M Klinger, M Ziętek
Ann Transplant 2003; 8(4): 57-62
Objectives. Gingival overgrowth is a common side effect of cyclosporine A (CsA) therapy. The pathogenesis of CsA-induced gingival overgrowth
is still debated. The influence of CsA dosage and its trough level, HLA phenotype, gender and the administered calcium channel blocker on
incidence and severity of overgrowth were studied. Moreover, relationship of overgrowth with plasma level of TGF-beta 1 was assessed.
Methods. Degree and extent of gingival overgrowth were tested in 124 kidney transplant recipients treated with CsA, in 9 patients treated with
azathioprine and in 21 patients treated with tacrolimus, and various calcium channel blockers.
Results. Gingival overgrowth was found in 46% of patients treated with CsA. Total yearly CsA dosage was significantly higher in patients with
overgrowth. Gingival overgrowth was observed in: 86% of patients treated with nifedipin, 47% with amlodipin, 35% with verapamil. HLA-DR
antigens analysis showed that half of the patients with DR-2 allele suffered from overgrowth. Gingival overgrowth was found twice as often in males than in females. Plasma level of TGF-beta1 was similar in patients with or without overgrowth. Gingival overgrowth was not found in patients treated with azathioprine or tacrolimus despite that half of the patients received nifedipine or amlodipine.
Conclusions. The study revealed high frequency of overgrowth in renal graft recipients treated with CsA. Overgrowth severity was larger in
patients treated simultaneously with nifedipine or amlodipine. CsA dosage, male sex and HLA-DR2 phenotype were risk factors of gingival
overgrowth. None of the patients treated with tacrolimus suffered from gingival overgrowth.