Prevalence and clinical characteristics of oral lesions in heart transplant patients induced by sirolimus and everolimus: a systematic review and meta-analysis on a global scale

Anne Evelyn Oliveira Moura; Mariana Oliveira Besseler; Maria Eduarda Pérez-de-Oliveira; Ana Gabriela Costa Normando; Itamara Lucia Itagiba Neves; Ricardo Simões Neves; Pablo Agustin Vargas; Estela Azeka; Alan Roger Santos-Silva; Tânia Cristina Pedroso Montano

doi:10.1016/j.oooo.2023.09.009

Prevalence and clinical characteristics of oral lesions in heart transplant patients induced by sirolimus and everolimus: a systematic review and meta-analysis on a global scale

Oral Surg Oral Med Oral Pathol Oral Radiol. 2024 Jan;137(1):37-52. doi: 10.1016/j.oooo.2023.09.009. Epub 2023 Oct 2.

Affiliations

¹ Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil. Electronic address: aeomoura@gmail.com.
² Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
³ Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas, Medical School, University of São Paulo (HCFMUSP), São Paulo, Brazil.
⁴ Pediatric Cardiology Unit, Instituto do Coração (InCor), Hospital das Clínicas, Medical School, University of São Paulo (HCFMUSP), São Paulo, Brazil.
⁵ Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas, Medical School, University of São Paulo (HCFMUSP), São Paulo, Brazil.

PMID: 37925270
DOI: 10.1016/j.oooo.2023.09.009

Abstract

Objective: Sirolimus (SRL) and everolimus (EVL) are increasingly included in immunosuppressive protocols after heart transplantation. They present some side effects, including the appearance of painful lesions in the oral cavity. Therefore, this systematic review aimed to verify the global prevalence and clinical characteristics of oral lesions induced by SRL and EVL in heart transplant patients.

Study design: A systematic review was performed using 5 main electronic databases (Medline/PubMed, SCOPUS, EMBASE, Web of Science, and LILACS), in addition to the gray literature. Studies were independently assessed by 2 reviewers based on established eligibility criteria. The risk of bias was assessed using the Joanna Briggs Institute appraisal tools, and the certainty of evidence was evaluated through GRADE assessment.

Results: Seventeen studies (860 patients) were included in the qualitative analysis. Of these, 11 studies were pooled in a meta-analysis of prevalence. The worldwide prevalence of oral lesions induced by SRL and EVL in heart transplant patients was 10.0%, and most lesions were described as ulcers >1.0 cm, related to significant pain.

Conclusions: Oral lesions induced by SRL and/or EVL, although not very prevalent, have a relevant impact on patient's lives and the continuity of treatment.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Everolimus* / adverse effects
Heart Transplantation* / adverse effects
Humans
Immunosuppressive Agents / adverse effects
Prevalence
Sirolimus / adverse effects

Substances

Everolimus
Sirolimus
Immunosuppressive Agents