Effect of donor smoking on survival after lung transplantation: a cohort study of a prospective registry

Bonser, Robert S.; Taylor, Rhiannon; Collett, David; Thomas, Helen; Dark, John H.; Neuberger, James

doi:10.1016/s0140-6736(12)60160-3

Cited by 134 publications

(74 citation statements)

References 30 publications

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“…Donor cigarette use emerged as a significant risk factor for grade 3 PGD, consonant with prior findings of mortality (21). The United Network for Organ Sharing defined donor smoking history of more than 20 pack-years fails to include active smokers with less than 20 pack-years of tobacco exposure and was not statistically significantly associated with grade 3 PGD, possibly because of the small number of high pack-year donors identified in the cohort.…”

Section: Discussionsupporting

confidence: 67%

“…The primary definition of grade 3 PGD at 48 or 72 hours after transplant was associated with a relative risk (RR) of 4.8 (95% CI, 3.3-7.0; P , 0.001) for death within 90 days of transplant compared with those without grade 3 PGD and an ARI of 18% (95% CI, 12-24). Grade 3 PGD was associated with a significantly increased 1-year mortality (RR, 3.0; 95% CI, 2.3-3.9; P , 0.001) compared with those without grade 3 PGD, and an ARI of 23% (95% CI, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Although the magnitude of the association between grade 3 PGD and mortality was attenuated when the alternate definition of any grade 3 PGD within 72 hours was used in the sensitivity analyses, the association remained significant at 90 days (RR, 3.5; 95% CI, 2.3-5.1; P , 0.001) and 1 year (RR, 2.5; 95% CI, 1.9-3.3; P , 0.001) (see Table E6).…”

Section: Resultsmentioning

confidence: 99%

“…However, given the limited pool of available lung donors, it is not currently feasible to exclude patients who were previous smokers as potential lung donors. A recent Lancet study demonstrated that, although recipient survival was worse after receipt of a lung from a smoking donor compared with a nonsmoking donor, overall survival was significantly better than if the recipient continued on the wait list (21). However, given that current methods of determining donor smoking history from interview of surrogates may be prone to measurement bias, we believe that more accurate quantification of smoking exposure in donors and research into mechanisms of donor smoking on increasing grade 3 PGD risk are important priorities for future investigation (24,25).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

Diamond¹,

Lee²,

Kawut³

et al. 2013

The Journal of Heart and Lung Transplantation

154

294

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Rationale: Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors. Objectives: We sought to identify donor, recipient, and perioperative risk factors for PGD. Methods: We performed a 10-center prospective cohort study enrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was International Society for Heart and Lung Transplantation grade 3 PGD at 48 or 72 hours posttransplant. The association of potential risk factors with PGD was analyzed using multivariable conditional logistic regression. Measurements and Main Results: A total of 1,255 patients from 10 centers were enrolled; 211 subjects (16.8%) developed grade 3 PGD. In multivariable models, independent risk factors for PGD were any history of donor smoking (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.6; P ¼ 0.002); FI O 2 during allograft reperfusion (OR, 1.1 per 10% increase in FI O 2 ; 95% CI, 1.0-1.2; P ¼ 0.01); single lung transplant (OR, 2; 95% CI, 1.2-3.3; P ¼ 0.008); use of cardiopulmonary bypass (OR, 3.4; 95% CI, 2.2-5.3; P , 0.001); overweight (OR, 1.8; 95% CI, 1.2-2.7; P ¼ 0.01) and obese (OR, 2.3; 95% CI, 1.3-3.9; P ¼ 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1-5.6; P ¼ 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6-7.7; P ¼ 0.002); and mean pulmonary artery pressure (OR, 1.3 per 10 mm Hg increase; 95% CI, 1.1-1.5; P , 0.001). PGD was significantly associated with 90-day (relative risk, 4.8; absolute risk increase, 18%; P , 0.001) and 1-year (relative risk, 3; absolute risk increase, 23%; P , 0.001) mortality. Conclusions: We identified grade 3 PGD risk factors, several of which are potentially modifiable and should be prioritized for future research aimed at preventative strategies. Clinical trial registered with www.clinicaltrials.gov (NCT 00552357). What This Study Adds to the FieldWe performed a multicenter, prospective cohort study of 1,255 lung transplant recipients across 10 US transplant centers. We identified receipt of an organ from a donor with any smoking history, elevated FI O 2 during allograft reperfusion, preoperative sarcoidosis or pulmonary arterial hypertension, use of cardiopulmonary bypass, single lung transplant, large-volume blood product transfusion, elevated pulmonary arterial pressures, and overweight or obese recipient body habitus as risk factors for grade 3 PGD. Several of these risk factors are potentially modifiable, and thus may suggest preventative strategies, whereas other risk factors should be prioritized for future mechanistic research efforts.

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Section: Discussionsupporting

confidence: 67%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

Diamond¹,

Lee²,

Kawut³

et al. 2013

The Journal of Heart and Lung Transplantation

154

294

View full text Add to dashboard Cite

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“…18 Additionally in all recipients of lung transplant, patients who received lungs from smoking donors had a lower hazard of death than those who remained on the waiting list. 19 In our current study, we used a large database of post LTx CF patients to determine a negative effect on posttransplant outcomes from donors with a smoking history greater than 20 packyears. This finding should be considered by clinicians regarding lung allocation for patients with CF, who represent a specific population at risk of complications from smoking-induced dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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Objectives: The effect of prior cigarette use by lung transplant donors and recipients on posttransplant survival is poorly defined, especially in subjects with cystic fibrosis. We sought to determine if donor or recipient cigarette smoking is associated with differential postlung transplant outcomes in cystic fibrosis patients, including survival. Materials and Methods: The United Network for Organ Sharing database was searched to analyze a large sample of cystic fibrosis patients with a history of lung transplant. The primary endpoint of the study was overall survival after transplant based on either recipient or donor history of smoking cigarettes. Results: There was a significant decrease in survival for cystic fibrosis patients who received lungs from a donor with a history of smoking (P = .026), but no difference in survival for recipients with a personal history of smoking. Nearly 60% of subjects who received lungs from a smoking donor died during the study. Donor smoking history was correlated with survival in a univariate (HR 1.2, [1.04-1.3]), but not multivariate model. Donor smoking history also was associated with increased treatment for rejection within the first year after transplant (P = .005). Conclusions:More than 20 pack-year history of donor smoking may affect lung transplant outcomes (eg, survival and acute rejection) in patients with cystic fibrosis. Caution must be exercised when choosing suitable organ donors for cystic fibrosis patients requiring a lung transplant.

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“…163 A larger analysis of 1295 lung transplantations in the UK found that 510 involved organs from donors with positive smoking histories. 164 Using a case-control design, investigators found that patients who received lungs from smoking donors had lower maximum FEV 1 in the 2 years following transplantation, and lower 30-day, 90-day, and 3-year survival. Median survival was reduced from 6.5 years to 4.9 years for recipients of smoking donor lungs.…”

Section: Extended Criteria Donationmentioning

confidence: 99%

Lung transplantation for chronic obstructive pulmonary disease

Liou¹,

Raman²,

Cahill³

2013

TRRM

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Abstract:Patients with end-stage chronic obstructive pulmonary disease (COPD) comprise the largest single lung disease group undergoing transplantation. Selection of appropriate candidates requires consideration of specific clinical characteristics, prognosis in the absence of transplantation, and likely outcome of transplantation. Increased availability of alternatives to transplantation for end-stage patients and the many efforts to increase the supply of donor organs have complicated decision making for selecting transplant candidates. Many years of technical and clinical refinements in lung transplantation methods have improved survival and quality of life outcomes. Further advances will probably come from improved selection methods for the procedure. Because no prospective trial has been performed, and because of confounding and informative censoring bias inherent in the transplant selection process in studies of the existing experience, the survival effect of lung transplant in COPD patients remains undefined. There is a lack of conclusive data on the impact of lung transplantation on quality of life. For some patients with end-stage COPD, lung transplantation remains the only option for further treatment with a hope of improved survival and quality of life. A prospective trial of lung transplantation is needed to provide better guidance concerning survival benefit, resource utilization, and quality of life effects for patients with COPD.

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Effect of donor smoking on survival after lung transplantation: a cohort study of a prospective registry

Cited by 134 publications

References 30 publications

Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

Untitled

Lung transplantation for chronic obstructive pulmonary disease

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