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

Abstract

Tobacco use is more prevalent among alcohol liver disease (ALD) transplant patients and exerts harmful effects to the patient and to the graft. The aims of this study were to examine the impact of smoking status (nonsmoker, ex-smoker, active smoker) on patient survival and clinical outcomes, and to assess risk factors for active smoking before and after liver transplant (LT). An observational retrospective cohort study with 314 ALD patients undergoing LT from January 2004 to April 2016. Recipients were followed until April 2017 or death. Kaplan–Meier and Cox proportional hazards regression analyses were used to assess risk of mortality according to smoking status before LT. Smokers had a 79% higher risk of dying than those who had never smoked or quit smoking before LT. Ex-smokers had a greater survival probability (96.2%, 93.8%, 86.9%, and 83.1% at 1, 3, 5, and 10 years after LT) than active smokers until LT (96.0%, 85.6%, 80.0%, and 70.4%). Active smokers before LT with poor toxicity awareness had more than a twofold higher risk of mortality (Cox HR = 2.20, 95% CI: 1.05–4.58, p = 0.04) than ex-smokers. Younger age (OR = 94), higher Model for End-Stage Liver Disease (MELD) (OR = 1.06), and comorbid substance use disorder (OR = 2.35) were predictors of smoking until LT. Six months or less of alcohol abstinence (OR = 3.23), and comorbid substance use disorder (OR = 4.87) were predictors of active smoking after LT. Quitting smoking before transplantation improved survival. Evidence based smoking cessation interventions should be offered before and after LT.

Association between smoking and non-alcoholic fatty liver disease in Southeast Asia

“…Kishore et al evaluated the frequency of hardcore smoking among three Southeast Asian countries, with India reporting the highest number of hardcore smokers as compared to Bangladesh, and Thailand, among a total of 31.3 million individuals ( 14 ). A serious public health issue, smoking kills more than 8 million people every year, and is a preventable cause of early disability and morbid mortality ( 15 , 16 ). According to a 2017 research, the percentage of men and women who smoke every day is 25.0 percent and 5.4 percent, respectively.…”

“…Patients in the last stages of liver disease, particularly those with severe alcoholic liver disease, benefit greatly from liver transplantation ( 16 , 46 ). Tobacco smoking has been linked to poor liver transplant results in several studies ( 15 , 16 ). An increased risk of non-graft-related death is attributed to poor heart and lung function as well as infection susceptibility and immune system dysfunction ( 15 , 16 ).…”

“…Tobacco smoking has been linked to poor liver transplant results in several studies ( 15 , 16 ). An increased risk of non-graft-related death is attributed to poor heart and lung function as well as infection susceptibility and immune system dysfunction ( 15 , 16 ). The prevalence of active smoking among patients before and after liver transplantation is 52 and 44%, respectively ( 15 ).…”

“…An increased risk of non-graft-related death is attributed to poor heart and lung function as well as infection susceptibility and immune system dysfunction ( 15 , 16 ). The prevalence of active smoking among patients before and after liver transplantation is 52 and 44%, respectively ( 15 ). Among alcoholic liver disease liver transplant recipients, cardiovascular events and cancer are notably identified as the leading causes of death ( 15 , 16 ).…”

Working towards an ERAS Protocol for Pancreatic Transplantation: A Narrative Review

“…Smoking is also associated with post-transplant malignancy, and cardiovascular events post kidney transplantation [ 34 , 35 ]. Within liver transplantation, active smokers at the time of transplant had an increased risk of mortality from cardiovascular causes and sepsis [ 36 ], with smoking cessation before transplant associated with increased survival [ 37 ]. Most interestingly, there was an increased length of hospital stay (13.4 vs. 7.9 days; p = 0.02) and increased cost of admission ($129,185 vs. $99,694; p = 0.02) in smokers vs. non-smokers [ 38 ].…”