Effects of Smoking on Survival for Patients with End-Stage Liver Disease

Lee, Dennis S.; Mathur, Amit K.; Acker, William B.; Al-Holou, Shaza N.; Ehrlichman, Lauren K.; Lewin, Sarah A.; Nguyen, Christine; Peterson, Sarah F.; Ranney, David N.; Sell, Kristen; Kubus, James; Englesbe, Michael J.

doi:10.1016/j.jamcollsurg.2009.01.050

Cited by 22 publications

(16 citation statements)

References 7 publications

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“…Tobacco use at the time of liver transplant assessment has been shown to be associated with increased all-cause mortality post-transplant[12,26]. However, the increased mortality rate post liver transplant in smokers appears to be non-graft-related.…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, whether to use abstinence from smoking as a transplant selection criterion for liver transplantation remains an ethical challenge[10–12]. The key issue is to understand the true impact of smoking prior to transplantation on outcomes, especially early mortality and morbidity, after liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, they both admitted that not all studies supported their conclusion. More specifically, a retrospective study of 2260 patients with chronic liver disease who were evaluated for liver transplantation at the University of Michigan has shown that smoking was not associated with increased mortality risk at any time point in those evaluated or receiving transplants[12]. Unfortunately, neither of the reviews used meta-analytic techniques.…”

Section: Introductionmentioning

confidence: 99%

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

Li¹,

Wang²,

Ma³

et al. 2017

PLoS ONE

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Li¹,

Wang²,

Ma³

et al. 2017

PLoS ONE

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“…Smoking is a common habit among liver transplant patients, with increasing evidence showing that it causes adverse events after transplantation 2. Although it may not affect short‐term mortality (ie, 2 years after transplantation), some differences have been noted in longer term survival 2.…”

Section: Discussionmentioning

confidence: 99%

“…Smoking is a behavior that tends to be common among liver transplant recipients, with 33.6% of these patients reporting themselves to be active or former tobacco users 2. Most transplant programs across North America do not require a patient to discontinue smoking in order to be eligible for transplantation 3.…”

mentioning

confidence: 99%

Smoking increases recurrent viral hepatitis after liver transplantation

Bhat¹,

Deschênes²,

Tan³

et al. 2012

Liver Transpl

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Smoking is a common behavior among transplant candidates. The aim of this study was to evaluate the effects of smoking on a range of complications after liver transplantation. We reviewed data about patient demographics and various complications after liver transplantation that were recorded in the McGill University Health Centre liver transplant database over a 14-year period. v 2 and multivariate analyses were performed. Four hundred forty-four liver transplants were performed from 1990 to 2004, and 63 were repeat transplants. Only primary liver transplant recipients were included in our analysis. Smokers (ie, active or former smokers) were more likely to be male (77.9% versus 62.7%, P ¼ 0.009) and Caucasian (88.4% versus 78.0%, P ¼ 0.03). The median survival time was 13.23 years for smokers and was not estimable for nonsmokers because of censoring. The median recurrent viral hepatitis-free survival time was 0.87 years for smokers and 4.10 years for nonsmokers (P ¼ 0.03). The following variables were not found to be associated with the smoking status: patient survival (P ¼ 0.78), time to biliary complications after liver transplantation (P ¼ 0.67), time to the first rejection episode after liver transplantation (P ¼ 0.61), and time to depression after liver transplantation (P ¼ 0.67). A Cox proportional hazards regression showed that recurrent viral hepatitis-free survival was still strongly associated with smoking [HR ¼ 2.04, 95% confidence interval (CI) ¼ 1.13-3.68, P ¼ 0.018] and was marginally associated with East Asian race (HR ¼ 0.26, 95% CI ¼ 0.06-1.06, P ¼ 0.06) and male sex (HR ¼ 0.59, 95% CI ¼ 0.34-1.02, P ¼ 0.06). In conclusion, recurrent viral hepatitisfree survival was decreased for smokers after liver transplantation, likely because of the adverse effects of tobacco on immunological host defenses. Overall, the biliary complication-free, depression-free, and rejection-free survival rates were similar for smokers and nonsmokers. These findings suggest that smoking cessation should be encouraged, particularly in recipients undergoing transplantation for viral hepatitis.

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Long‐Term Outcome After Liver Transplantation

Lim

Schiano

2012

Mount Sinai J Medicine

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Liver transplantation is a life-saving therapy for patients with end-stage liver disease, acute liver failure, and liver tumors. Over the past 4 decades, improvements in surgical techniques, peritransplant intensive care, and immunosuppressive regimens have resulted in significant improvements in short-term survival. Focus has now shifted to addressing long-term complications and improving quality of life in liver recipients. These include adverse effects of immunosuppression; recurrence of the primary liver disease; and management of diabetes, hypertension, dyslipidemia, obesity, metabolic syndrome, cardiovascular disease, renal dysfunction, osteoporosis, and de novo malignancy. Issues such as posttransplant depression, employment, sexual function, fertility, and pregnancy must not be overlooked, as they have a direct impact on the liver recipient's quality of life. This review summarizes the latest data in long-term outcome after liver transplantation.

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Effects of Smoking on Survival for Patients with End-Stage Liver Disease

Cited by 22 publications

References 7 publications

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

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

Smoking increases recurrent viral hepatitis after liver transplantation

Long‐Term Outcome After Liver Transplantation

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