Patient survival after renal transplantation: II. The impact of smoking

Abstract

Renal transplant recipients have significantly higher mortality than individuals without kidney disease and the excess mortality is mainly due to cardiovascular causes. In this study, we sought to determine the impact of smoking, a major cardiovascular risk factor, on patient and renal graft survival. The study population included all adult recipients of first cadaveric kidney transplants done in our institution from 1984 to 1991. By selection, all patients were alive and had a functioning graft for at least 1 yr after transplantation. Smoking history was gathered prior to transplantation. The follow‐up period was 84.3±41 months and during this time 28% of the patients died and 21% lost their graft. By univariate and multivariate analysis, patient survival, censored at the time of graft loss, correlated with these pre‐transplant variables: age (p<0.0001); diabetes (p=0.0002); history of cigarette smoking (p=0.004); time on dialysis prior to the transplant (p=0.0005); and cardiomegaly by chest X‐ray (p=0.0005). Post‐transplant variables did not correlate with patient mortality. By Cox regression, patient survival time was significantly shorter in diabetics (p<0.0001), smokers (p=0.0005), and recipients older than 40 yr. However, there were no significant differences between the survival of smokers, non‐diabetics, diabetics, and older recipients. Patient death was the most common cause of renal transplant failure in smokers, in patients older than 40 yr, and in diabetics, but these patient characteristics did not correlate with graft survival. The prevalence of different causes of death was not significantly different between smokers and non‐smokers. In conclusion, a history of cigarette smoking correlates with decreased patient survival after transplantation, and the magnitude of the negative impact of smoking in renal transplant recipients is quantitatively similar to that of diabetes.

Smoking

“…The data document that smoking is by far the strongest modifiable predictor of mortality in these elderly patients. These data have largely been confirmed by others (104), even in younger individuals (102). The magnitude of the negative effect of pretransplantation smoking is quantitatively similar to that of diabetes (102).…”

Ischemic Heart Disease after Renal Transplantation in Patients on Cyclosporine in Spain

“…This finding can be attributed to the high percentage of transplant recipients with hypertension both before and after transplantation, which makes this factor have little discriminating capacity, or to the systematic treatment of hypertension that reduces the adverse effects in this population. Cigarette smoking has been associated with posttransplantation IHD (6,7,10) and with mortality (24,25). Our data confirmed the association between smoking and IHD.…”

Cigarette smoking and chronic kidney diseases

“…These reports suggest that active smoking is a potential risk factor for graft loss [24][25][26][27] and mortality. 25,28 A retrospective cohort study comprising 1334 renal transplant recipients at the Henepin County Medical Center in the United States found that a smoking history of 425 pack-years was significantly associated with a 30% increase in risk of graft failure, whereas a history of o25 pack-years did not affect graft survival. 25 This study also suggested that the higher rate of graft loss in recipients with a history of heavy smoking was caused by higher mortality as compared with non-smokers.…”