Cigarette Smoking and Its Hazards in Kidney Transplantation

Abstract

Cigarette smoking affects many organs. It causes vasoconstriction through activation of sympathetic nervous system which leads to elevation of blood pressure and reduction in glomerular filtration rate and filtration pressure. It also causes thickening of renal arterioles. Cigarette smoking increases the risk of microalbuminuria and accelerates progression of microalbuminuria to macroalbuminuria. Furthermore, it causes rapid loss of glomerular filtration rate in chronic kidney disease patients. After kidney donation, these factors may be injurious to the solitary kidney. Kidney donors with history of cigarette smoking are prone to develop perioperative complications, pneumonia, and wound infection. Postkidney transplantation various stressors including warm and cold ischemia time, delayed graft function, and exposure to calcineurin inhibitors may result in poor graft function. Continuation of cigarette smoking in kidney transplant recipients will add further risk. In this review, we will specifically discuss the effects of cigarette smoking on normal kidneys, live kidney donors, and kidney transplant recipients. This will include adverse effects of cigarette smoking on graft and patient survival, cardiovascular events, rejection, infections, and cancers in kidney transplant recipients. Lastly, the impact of kidney transplantation on behavior and smoking cessation will also be discussed.

Marijuana use should not preclude consideration for kidney transplantation

“…We found no significant difference in eGFR at one year among groups which is aligned with findings from Kasiske et al Several studies found worsened renal function among kidney transplant recipients with tobacco use history compared to nonusers or never smokers . Tobacco use may potentially have deleterious effects on kidney function given the upregulation of sympathetic output and potential to cause proteinuria . Perhaps a follow‐up period of greater than one year is necessary to realize the negative impact of tobacco use on renal function.…”

“…Several fungal species have been cultured from marijuana products from Californian dispensaries, but literature is limited to case reports of fungal pneumonia in transplant patients . Tobacco use in non‐kidney transplant recipients has been associated with several pulmonary infections including varicella, tuberculosis, pneumococcus, and legionella . We did not find a difference in pneumonia rates among marijuana‐only users, tobacco‐only users, marijuana and tobacco users, and nonusers within the first‐year post‐transplant.…”

Associations between High Serum Adipocyte Fatty Acid Binding Protein and First Hospitalization in Kidney Transplantation Patients: A 5-Year Follow-up Study

“…Therefore, further longitudinal larger-scale multicenter researches are needed to validate these results. Second, some confounders, such as smoking, were not included and may have influenced this study’s predictive power [ 37 ]. Third, the serum FABP4 levels are affected by the production of adipocytes, enhanced secretion via lipolysis and disposal via the kidney [ 12 ].…”

Is Early Complement Activation in Renal Transplantation Associated with Later Graft Outcome?

“…Negative effects of donor nicotine consumption are known and include impaired kidney function [28]. An association of donor smoking with DGF was only seen using bivariate analysis [29] but this relationship became insignificant when adjusted for correlated outcome data [30].…”