role of pretransplant smoking on allograft survival in kidney recipients

ABSTRACT

Cigarette smoking contributes to a number of health-related problems, but its impact on allograft survival in kidney recipients is not clear. This study was performed to evaluate the relationship between smoking and graft survival. A total of 199 adult kidney recipients were enrolled in this study. All transplantations had been done in our center and all grafts had been taken from living donors. The patients were asked about their cigarette smoking behavior before transplantation and assessed for diabetes mellitus, hypertension, and hyperlipidemia, pre- and post-operatively. Of 199 recipients, 142 [71.4%] were male and 57 [28.6%] were female. They were 40.45 [range 18 to 65] years old. Forty-one recipients [20.6%] were smokers before kidney transplantation that 87.7% of them continued smoking after transplantation. Mean pack-year smoking was 13.2. Of the patients, 32.7% and 33.7% had hypertension, 19.3% and 23.1% had diabetes mellitus, and 46.2% and 42.2% had hyperlipidemia, before and after transplantation, respectively, showing no significant difference. Pretransplant smoking was significantly associated with reduced overall graft survival [P = 0.01], but no correlation between smoking cessation after transplantation with survival graft was found. Cigarette smoking before kidney transplantation contributes significantly to allograft loss. However, smoking is not associated with increase in rejection episodes. Although we could not prove it, smoking cessation after renal transplantation may have beneficial effects on graft survival. These effects should be emphasized for patients with end-stage renal disease who are candidates for kidney transplantation