HOLLY GİLLOTT, FRANCESCA JACKSON SPENCE, SANNA TAHİR, JEMMA MYTTON, FELİCİTY EVİSON, JAY NATH, ADNAN SHARİF
Experimental and Clinical Transplantation - 2018;16(3):274-281
Objectives: How smoking history affects kidney allograft outcomes is unclear in the contemporary era of immunosuppression. Here, we examined a broad range of outcomes after kidney transplant, stratifying patients by smoking status documented at time of transplant, in a well-characterized clinical cohort. Materials and Methods: This retrospective single-center analysis (2007-2015) included 744 kidney allograft recipients who had documentation of smoking exposure (median follow-up 1327 days post - transplant). Biochemistry, clinical outcome, histo - pathology, and patient and graft survival data were extracted. Results: Overall, 264 kidney allograft recipients (35.5%) had smoking exposure (current or ex-smoker) documented at time of transplant; these were more likely to be white male patients. Patients with versus without smoking exposure had higher rates of posttransplant cancer (10.2% vs 4.6%; P = .003) and cardiac events (11.7% vs 4.6%; P < .001) but lower risk of requiring hospitalization with septicemia (5.7% vs 10.0%; P = .027). Patients with versus without smoking exposure had increased rates of 1-year rejection (14.8% vs 10.4%; P = .052), thrombotic microangiopathy (4.2% vs 1.0%; P = .006), recurrent disease (4.2% vs 1.0%; P = .006), and a trend toward more acute tubular injury (16.7% vs 12.3%; P = .063). Overall, smoking exposure was associated with increased risk of death (9.5% vs 4.6%; P = .008), death-censored graft failure (13.6% vs 7.9%; P = .010), and overall graft failure (21.6% vs 11.7%; P < .001). In a Cox regression model of baseline variables, smoking exposure was independently associated with overall graft failure (hazard ratio 1.68; 95% confidence interval, 1.21-2.32; P = .002). Conclusions:Our results confirm that smoking exposure at time of kidney transplant remains associated with adverse outcomes in the contemporary era. These results reinforce the need to develop robust smoking cessation strategies to encourage kidney transplant candidates to stop smoking to improve posttransplant outcomes.
