Impact of cigarette smoking on early complications after liver transplantation: A single-center experience and a meta-analysis

Abstract

BackgroundWhile studies have shown that cigarette smoking has negative implications on the long-term outcome following liver transplantation, its role in early complications is inconclusive.MethodsThe clinical data of 162 consecutive adult patients who underwent elective liver transplantation from January, 2012 to March, 2016 were analyzed. Patients were defined as active smokers, ex-smokers, or non-smokers on the basis of documentation at the time of liver transplantation. The overall complications following liver transplantation were expressed as the comprehensive complication index (CCI). The specific complications such as the incidence of hepatic artery thrombosis, biliary complications, acute kidney injury were also assessed. A meta-analysis was carried out based on results from the present study and 11 published studies.ResultsWe found that cigarette smoking was not associated with higher CCI scores and smokers did not have a higher risk for developing hepatic artery thrombosis, biliary complications, acute kidney injury after liver transplantation. Meta-analysis confirmed the null association between cigarette smoking and an increased incidence of hepatic artery thrombosis or biliary complications in liver transplant recipients. However, the pooled results showed a significantly higher risk of cardiovascular diseases and de-novo malignancies in smokers following liver transplantation.ConclusionThere is not enough evidence supporting an association between cigarette smoking and early mortality and morbidity after liver transplantation. However, smokers should still be encouraged to quit before and after liver transplantation due to the long-term health benefits of smoking cessation.

Active Smoking Before Liver Transplantation in Patients with Alcohol Use Disorder: Risk Factors and Outcomes

“…The current study emphasizes that smoking is related to worse LT outcomes. Similar to our findings, there is evidence that smoking history correlates with development of cancer after LT [ 8 , 9 , 20 , 21 , 22 ], especially among ALD patients, with the joint use of alcohol and tobacco having higher carcinogenic effects [ 23 , 24 ].…”

“…Tobacco is a risk factor for cardiovascular events and cancer, which are among the main causes of death of LT patients [ 8 , 9 ]. There is evidence of the harmful effects derived from smoking to the patient (de novo malignancy, cardiovascular disease) and to the graft (hepatic artery thrombosis, biliary complications) [ 10 ].…”

Intensive Care of Pulmonary Complications Following Liver Transplantation

“…39 In addition, malnutrition and sarcopenia are also major contributors to restrictive lung disease in cirrhosis and can be alleviated by supplemental calorie and protein intake in addition to increased physical activity. 40,41 Hepatopulmonary syndrome and POPH are 2 distinct pulmonary vascular disorders that can occur in cirrhotic disease. Hepatopulmonary syndrome results from changes in the pulmonary microvasculature leading to an impairment in gas exchange diagnosed on echocardiography with agitated saline demonstrating the presence of microbubbles in the left cardiac chambers late in the cardiac cycle 42,43 but can also be detected on lung perfusion imaging.…”

Influence of donors’ cigarette smoking on recipients’ postoperative survival and complications after simultaneous pancreas-kidney transplantation

“…Our research suggests donors' history of cigarette smoking increase the risk for postoperative infection. The results of other studies also support the ndings that cigarette smoking can cause dysfunction, functional delays, infection and other postoperative complications of liver, kidney and lung transplants [9,22,23]. Therefore, although there is controversy about whether donors' cigarette history in uence recipients' survival, smoking should be discouraged and quitting smoking encouraged before surgery, with the aim of increasing the bene ts of survival and decreasing the risk of complications through smoking cessation.…”