Gingival hyperplasia in renal allograft recipients receiving cyclosporin‐A and calcium antagonists

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Abstract
Although it is established that the immunosuppressant cyclosporin‐A (CsA) and calcium antagonists [Nifedipine (Nif) and Diltiazem (Dz)] can independently induce gingival enlargement, little has been documented on the significance of the salivary CsA levels and the combined effect of CsA and a calcium antagonist upon gingival tissues. In the present cross‐sectional investigation, clinical periodontal parameters and the pharmacologic profiles of CsA, Nif, and Dz were determined for 66 renal transplant recipients. Subjects were divided into the following groups: Group (Gp) I: CsA [n=18]; Gp 2: CsA + Nif [n=15]; Gp 3: CsA + Dz [n=12] and a negative Control Gp 4: azathioprine [n=21]. A gingival enlargment score was assessed for each patient from study models using a byperplastic index (HI). Pharmacologic profiles included CsA whole blood and whole saliva levels as measured by fluorescence polarization immunoassay. The HI scores between Gp 1, 2 and 3 were not significantly different. However, when compared with controls (Gp 4), there was a significant difference in HI and all individual groups (Gp 1, 2, 3) (p<0.05). Gingival hyperplasia was only weakly related to plaque and calculus but was unrelated to CsA dose (mg/kg/day), duration of CsA therapy (months), CsA blood or saliva levels (ng/ml), or the concurrent administration of a Nif or Dz. Gingival enlargement was found to occur in 49% of subjects who were either on CsA or CsA and a calcium antagonist. It is concluded that CsA alone or in combination with a calcium antagonist caused a significant increase in gingival enlargement compared with controls. However, the CsA effect in inducing gingiva] hyperplasia did not appear to be potentiated by the addition of a calcium antagonist.