Establishment of Oral Management Method for Heart Transplant Patients Using Oral Microbiome as an Index

2021 Fiscal Year Final Research Report

• Project/Area Number: 18K09817
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 57060:Surgical dentistry-related
• Research Institution: Kyushu University
• Principal Investigator: Imai Yuko 九州大学, 大学病院, 助教 (30592688)
• Co-Investigator(Kenkyū-buntansha): 柏崎 晴彦 九州大学, 歯学研究院, 教授 (10344516)
• Project Period (FY): 2018-04-01 – 2022-03-31
• Keywords: 補助人工心臓 / 心臓移植 / 出血傾向

Outline of Final Research Achievements

We analyzed the relationship between tooth extraction, blood data, and complications in patients before and after ventricular assist device(VAD) implantation. Device type, prolongation of APTT-T, increase in mean arterial pressure and decrease in pulse pressure, and antithrombotic therapy were considered as factors for post-extraction bleeding. To evaluate the unique oral bacterial dynamics in patients with VAD and heart transplant recipients, saliva was collected from 14 consenting VAD and 10 heart transplant recipients. All of the former patients were on antithrombotic therapy and 3 patients were on long-term antibiotic therapy. The latter were all on immunosuppressants, 9 on antithrombotic therapy, and 7 on antibiotics, steroids, and bisphosphonate(BP). There was a tendency that the bacterial flora composition of patients with a long VAD wearing period was similar to that of patients with a short number of days after heart transplantation.

Free Research Field

有病者歯科

Academic Significance and Societal Importance of the Research Achievements

心臓移植適応とされてから補助人工心臓（VAD）装着、心臓移植後までは、出血や感染など歯科処置を行う上で慎重な管理が必要であるにも関わらず、口腔管理に関する指針はない。これまでの研究で、VAD装着時期の患者は歯科での観血的処置は避けた方がよいことが示唆されたが、細菌学的な検討はできていなかった。本研究では、VAD装着が長期間にわたる患者と、心臓移植後間もない患者すなわち直近まで長期VAD装着していた患者の細菌叢が比較的類似している傾向にあることが示唆された。VAD装着前、装着後、心臓移植後の口腔細菌叢の変化が明らかになれば、感染の制御や歯科治療を行う最適時期などの指針となることが期待される。