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Wiley InterScience | ||||||||
  American Journal of TransplantationVolume 8 Issue 4, Pages 866 - 871 Published Online: 6 Mar 2008 © 2010 American Society of Transplantation and the American Society of Transplant Surgeons
Abstract | References | Full Text: HTML, PDF (Size: 210K) | Related Articles | Citation Tracking  Brief Communication Smoking After Cardiac Transplantation This manuscript has been presented in part as an original scientific abstract at the 2006 annual meeting of the International Society for Heart and Lung Transplantation, Madrid, Spain. Copyright 2008 American Society of Transplantation and the American Society of Transplant Surgeons KEYWORDS Cardiac allograft vasculopathy • heart transplantation • malignancy • smoking ABSTRACTAlthough smoking cessation is a prerequisite prior to listing for cardiac transplantation, some patients return to smoking after recovery. We have covertly assessed the smoking habits of our cardiac transplant recipients (with ethical approval) since 1993 by measuring urinary cotinine: a level of >500 ng/mL signifying continued tobacco use. We retrospectively analyzed survival, causes of death and the development of graft coronary artery disease (GCAD) with respect to the number of positive and negative cotinine levels. One hundred four of 380 (27.4%) patients tested positive for active smoking at some point posttransplant, and 57 (15.0%) tested positive repeatedly. Smokers suffered significantly more deaths due to GCAD (21.2% vs. 12.3%, p < 0.05), and due to malignancy (16.3% vs. 5.8%, p < 0.001). In univariate analysis, smoking after heart transplantation shortened median survival from 16.28 years to 11.89 years. After correcting for the effects of pretransplant smoking in time-dependent multivariate analysis, posttransplant smoking remained the most significant determinant of overall mortality (p < 0.00001). We conclude that tobacco smoking after cardiac transplantation significantly impacts survival by accelerating the development of graft vasculopathy and malignancy. We hope that this information will deter cardiac transplant recipients from relapsing, and intensify efforts in improving cessation rates. Received 24 July 2007, revised 12 November 2007 and accepted for publication 05 December 2007 | 
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