History of cigarette smoking and heart transplant outcomes

Abstract

Background : Active cigarette smoking (CS) is a contraindication for Orthotopic Heart Transplantation (OHT) with a recommendation that HT candidates be free from CS for at minimum 6 months prior to HT. Animal studies have shown that a history of CS is associated with increased risk of allograft rejection, but few studies have examined the association of past CS and HT outcomes. Methods : Data were analyzed from HT recipients captured in the United Network for Organ Sharing (UNOS) transplant registry. Adults aged 18–79 who underwent HT from 1987 to 2018 and with data for all covariates (N = 32,260) were included in this study. The cohort was categorized by past smoking history (CS vs non-CS). Post-transplant outcomes of interest included survival, graft failure, treated rejection, malignancy and hospitalization for infection. Baseline characteristics were compared between the two groups using the chi-squared analysis. Unadjusted associations between CS and patient survival were determined using the Kaplan-Meier estimations and confounding was addressed using multivariable Cox proportional hazards models. Results : HT recipients with a history of CS were older (55 vs 50, p = <0.0001), more likely to be Caucasian (75.7 vs 62.3, p = <0.0001), male (81.7 vs 68.2, p =< 0.0001), and diabetic (27.4 vs 24.4, p =< 0.0001). CS was associated with significantly worse survival (HR: 1.23, p < 0.0001). A history of CS was also associated with increased risk of acute rejection (OR: 1.20, p < 0.0001), hospitalization for infection (OR:1.24, p < 0.0001), graft failure (OR:1.23, p < 0.0001) and post-transplant malignancy (OR:1.43, p < 0.0001). Conclusion : A history of CS is associated with increased risk of adverse events post OHT.

Psychosocial Risk and Health Behaviors as Predictors of Clinical Events in Patients Wait-Listed for a New Heart: Results from 7 Years of Follow-Up

“…One review study found 16% of heart failure patients continue to smoke after diagnosis, and that persistent smoking not only leads to increased mortality, as we saw in our study, but is also associated with increased risk of readmissions, poor health status, ventricular tachycardia, and arterial stiffness [9]. It is also problematic that among those with a history of smoking who are able to receive a heart transplant have a high risk of poor outcomes post-heart transplantation [55]. One study found 26% of current and former smokers who all stopped prior to heart transplantation resumed smoking after transplantation [56].…”

Management of long-term cardiovascular risk factors post organ transplant

“…HTR with a history of smoking have a higher risk of posttransplant mortality, malignancy, graft failure and hospitalizations for acute rejection and infection. An observational study conducted in the USA found that patients who consumed tobacco in the 12 months preceding transplantation were at a higher risk of mortality and graft failure among others [77]. Therefore, it is important to encourage patients to quit smoking by promoting programmes that motivate its cessation.…”

“…Tobacco exposure and smoking increase the risk of cardiovascular events such as coronary disease or thrombotic events by a variety of mechanisms: platelet dysfunction, altered endothelial function, oxidative processes, inflammation and lipid oxidation [77,78].…”

Impact of air pollution on postoperative outcomes following organ transplantation: Evidence from clinical investigations

“…Graft survival was decreased in the both group of donors and recipients which were exposed to tobacco smoke. [58][59][60] Furthermore, exposure to smoke was associated with increased systemic inflammatory cytokine, hospitalization of infection and mortality. 58,59 Posttransplant smoking in lung transplant patients was associated with declined of pulmonary function, but the study failed to demonstrate association of cigarette smoke and graft rejection.…”

“…[58][59][60] Furthermore, exposure to smoke was associated with increased systemic inflammatory cytokine, hospitalization of infection and mortality. 58,59 Posttransplant smoking in lung transplant patients was associated with declined of pulmonary function, but the study failed to demonstrate association of cigarette smoke and graft rejection. 61 In kidney transplantation, cigarette smoking was associated with decreased graft survival especially smoking at time of tranpslantaion, [62][63][64] hospitalization of infection, and death-censored graft failure.…”