How to manage cigarette smoking in kidney transplant candidates and recipients?

Abstract

Tobacco smoking is a frequent problem affecting many kidney transplant (KT) candidates and recipients. The negative impact of active smoking on KT outcomes has been demonstrated. Consequently, most guidelines strongly recommend quitting smoking before considering kidney transplantation. However, nicotine addiction is a complex multifactorial disease and only 3-5% of patients who try to quit by themselves, achieve prolonged abstinence. Smoking cessation programs (SCP) have proven their efficacy in the general population to increase the rate of quitting and should therefore be proposed to all smoking KT candidates and recipients. Nevertheless, SCP have not been evaluated in the KT field and not all KT centers have an easy access to these programs. In this work, we aim to review the current knowledge on the subject and provide an overview of available interventions to help smoking patients to quit. We detail non-pharmaceutical and pharmaceutical approaches and discuss their use in KT candidates and recipients.

Cardiovascular Risk after Kidney Transplantation: Causes and Current Approaches to a Relevant Burden

“…Smoking cessation may be associated with substantial health benefits for all smokers [ 141 ]. Since the successful rate of smoking cessation without a treatment is poor, smoking cessation programs are emerging as an important part of KT recipients’ treatment [ 142 ]. When counseling alone is not sufficient, a pharmacological treatment should be considered.…”

Abdominal wall complications after kidney transplantation: A clinical review

“…The prevalence of cigarette smoking among kidney transplant recipients is 25% and 35–40% in American and European patients, respectively, 43,44 with 90% who continue to smoke after KT 44 …”

“…The prevalence of cigarette smoking among kidney transplant recipients is 25% and 35-40% in American and European patients, respectively, 43,44 with 90% who continue to smoke after KT. 44 Patients with a history of smoking have a four-fold increased risk compared with nonsmokers, probably as a consequence of the decreased blood supply to the parietal wall, which impairs wound recovery and can predispose them to incisional hernia development.…”

“…The prevalence of cigarette smoking among kidney transplant recipients is 25% and 35-40% in American and European patients, respectively, 43,44 with 90% who continue to smoke after KT. 44 Patients with a history of smoking have a four-fold increased risk compared with nonsmokers, probably as a consequence of the decreased blood supply to the parietal wall, which impairs wound recovery and can predispose them to incisional hernia development. 7,34,39 Obesity is a growing problem among kidney transplant recipients, with more than a quarter of US waitlisted candidates with a BMI of 30 to < 35 kg/m 2 and 17.8% with a BMI of ≥ 35 kg/m 2 , and this incidence has continued to grow during the last two decades.…”

“…A well‐performed parietal closure is therefore a key element for reducing the risk of SSI and the risk of IH 21–59 . As a consequence of prolonged immunosuppressive therapy and the higher prevalence of comorbidities, renal recipients would be expected to be at higher risk of incisional hernia 6,60 .…”