The effect of smoking on biliary complications following liver transplantation

Abstract

Summary We sought to estimate the effect of smoking on the biliary complication rate following orthotopic liver transplantation. We retrospectively evaluated the records of liver transplant recipients at our center from July 1, 1999 to October 26, 2007. Using Cox proportional hazards models, we estimated the time to the earliest biliary complication (leak or stricture) based on smoking exposure, as active, former, or lifetime nonsmoker, adjusting for other clinical factors. Overall, 409 liver transplant recipients were evaluated. The overall biliary complication rate was 37.7% (n = 154). Biliary complications included 66 anastomotic leaks, 60 anastomotic strictures, and 28 nonanastomotic lesions. ERCP was the primary diagnostic modality (n = 112). 18.1% of liver transplant recipients were active smokers (n = 74) and 42.8% were former smokers (n = 175). Active smokers were at greatest risk for biliary complications on unadjusted analysis (P = 0.022). After multivariable adjustment, active smokers had a 92% higher rate of biliary complication rates compared with lifetime nonsmokers (HR 1.92, 95% CI 1.07–3.43), but no difference was noted in the rate of complication resolution. Smoking clearly portends a significant risk of biliary complications following liver transplantation. Smoking status should be clearly defined when evaluating transplant candidacy and in counseling patients with cirrhosis.

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

“…After de-duplication, 5644 articles were left for screening according to the titles and abstracts, with 78 records determined as potentially eligible. The full texts and data integrity of these studies were reviewed, and 8 articles and 3 additional articles retrieved through the references of the above were included in this meta-analysis (Fig 1)[2,3,5,20–27]. The characteristics of the included studies are presented in Table 5.…”

Risk factors of lung, head and neck, esophageal, and kidney and urinary tract carcinomas after liver transplantation: The effect of smoking withdrawal

“…Other complications associated with smoking are increased risks of infection,19 hepatic artery thrombosis and stenosis,20 and biliary complications 21. Furthermore, smoking is also a risk factor for cardiovascular disease,19, 22 and this is one of the most frequent causes of late mortality after liver transplantation 6.…”

Smoking increases recurrent viral hepatitis after liver transplantation

“…Smoking has been correlated with greater resource utilization and hospital charges over a 2‐year period after liver transplantation 11. Biliary strictures and leaks have been reported to be more common among active smokers, with a retrospective study documenting a 92% higher rate of biliary complications among patients who smoked 4. A higher incidence of vascular complications, including hepatic artery thrombosis, has been shown after transplantation in active smokers 5.…”

“…Despite the known adverse physiological effects of smoking, few studies have been conducted to assess whether smoking affects post–liver transplant outcomes. An increased incidence of biliary and vascular complications has been reported in this population in the short term 4‐6. In the longer term, all‐cause mortality, cardiovascular mortality, and sepsis‐related mortality are higher,7 and emerging evidence suggests that these patients are more susceptible to developing non–skin‐related malignancies 8.…”