Association Between Solid Organ Transplantation and Oral Candidiasis: A Systematic Review and Meta-Analysis.

AIM: To summarize the evidence on the association of oral candidiasis with solid organ transplantation in case-control and cohort studies.

METHODS

The quality of studies was assessed using the Newcastle-Ottawa scale. Random-effects restricted maximum likelihood model or Fixed-effects Mantel-Haenszel models were used to pool the results appropriately, and sensitivity analysis, subgroup analysis, and publication bias were assessed. The certainty of evidence was assessed using the GRADE approach.

RESULTS

The pooled OR of candidiasis in immunosuppressed individuals receiving solid organ transplants compared to controls was found to be 3.52 (95% CI: 1.92, 6.46; p < 0.05). The pooled OR of oral candidiasis in kidney transplant recipients compared to controls was 3.53 (95% CI: 1.92, 6.49; p < 0.05); for liver, 20.12 (95% CI: 3.83, 105.74; p < 0 .05), and heart, 152.01 (95% CI: 17.71, 1304.96; p < 0.05).

CONCLUSIONS

There was moderate certainty of evidence that there was an increased risk of oral candidiasis in immunosuppressed patients who received solid organ transplants compared to healthy controls. Similarly, the evidence was moderate for subgroup analysis regarding the kidney transplant recipients, liver transplant recipients, and heart transplant recipients. Due to the lack of current research, future research should evaluate the risk of oral candidiasis in patients receiving pancreas or small bowel transplants. Also, future studies should evaluate the role of prophylactic antifungals in immunosuppressed solid organ transplant recipients.

TRIAL REGISTRATION: PROSPERO number: CRD42022363816.