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Abstract

Objectives: How smoking history affects kidney allograft outcomes is unclear in the contemporary era of immunosuppression. Here, we examined a broad range of outcomes after kidney transplant, stratifying patients by smoking status documented at time of transplant, in a well-characterized clinical cohort. Results: Overall, 264 kidney allograft recipients (35.5%) had smoking exposure (current or ex-smoker) documented at time of transplant; these were more likely to be white male patients. Patients with versus without smoking exposure had higher rates of posttransplant cancer (10.2% vs 4.6%; P = .003) and cardiac events (11.7% vs 4.6%; P < .001) but lower risk of requiring hospitalization with septicemia (5.7% vs 10.0%; P = .027). Patients with versus without smoking exposure had increased rates of 1-year rejection (14.8% vs 10.4%; P = .052), thrombotic microangiopathy (4.2% vs 1.0%; P = .006), recurrent disease (4.2% vs 1.0%; P = .006), and a trend toward more acute tubular injury (16.7% vs 12.3%; P = .063). Overall, smoking exposure was associated with increased risk of death (9.5% vs 4.6%; P = .008), death-censored graft failure (13.6% vs 7.9%; P = .010), and overall graft failure (21.6% vs 11.7%; P < .001). In a Cox regression model of baseline variables, smoking exposure was independently associated with overall graft failure (hazard ratio 1.68; 95% confidence interval, 1.21-2.32; P = .002). Conclusions: Our results confirm that smoking exposure at time of kidney transplant remains associated with adverse outcomes in the contemporary era. These results reinforce the need to develop robust smoking cessation strategies to encourage kidney transplant candidates to stop smoking to improve posttransplant outcomes.

Impact of air pollution on postoperative outcomes following organ transplantation: Evidence from clinical investigations

“…61 In kidney transplantation, cigarette smoking was associated with decreased graft survival especially smoking at time of tranpslantaion, [62][63][64] hospitalization of infection, and death-censored graft failure. 63,64 However, another study had shown that acute rejection was similar in patients who smokers and non-smokers. 65 Even through some results were non-concordant which it is possible that smoking is a dose-dependent effect which required time to manifest its effects and it had wash-out effect if the period of abstinence is long enough, 56,59,64 smoking is hazardous and should be consider and encourage patients to abstinence.…”

“…58,59 Posttransplant smoking in lung transplant patients was associated with declined of pulmonary function, but the study failed to demonstrate association of cigarette smoke and graft rejection. 61 In kidney transplantation, cigarette smoking was associated with decreased graft survival especially smoking at time of tranpslantaion, [62][63][64] hospitalization of infection, and death-censored graft failure. 63,64 However, another study had shown that acute rejection was similar in patients who smokers and non-smokers.…”

Anaesthetic Approach to Enhanced Recovery after Surgery for Kidney Transplantation: A Narrative Review

“…However, another trial of kidney transplant patients suggests longer periods for smoking cessation [ 24 ]. Kidney allograft recipients who continued to smoke have a higher rate of post-transplant cancer and cardiac events, increased incidence of rejection at one year, and higher risk of death and overall graft failure [ 25 , 26 , 27 ].…”

“…Some authors recommend the use of e-cigarettes as an aid in quitting smoking. There is not enough evidence to support using e-cigarettes after solid organ transplantation [ 24 , 25 ]. Smokers with a history of more than 30 pack years should have computed tomography as a cancer screening test [ 16 ].…”