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Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation
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Published on: October 11, 2024

Smoking after cardiac transplantation.

P Botha1, R Peaston, K White

  • 1Department of Cardiopulmonary Transplantation, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK. P.Botha@ncl.ac.uk

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|March 8, 2008
PubMed
Summary

Smoking after heart transplant significantly increases mortality and graft coronary artery disease. Continued tobacco use is the primary risk factor for death in cardiac transplant recipients, highlighting the need for improved cessation programs.

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Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Oncology

Background:

  • Smoking cessation is mandatory before cardiac transplantation.
  • A significant number of heart transplant recipients relapse to smoking post-transplant.
  • Urinary cotinine levels are used to monitor tobacco use.

Purpose of the Study:

  • To assess the impact of post-transplant smoking on survival.
  • To analyze the relationship between smoking and graft coronary artery disease (GCAD).
  • To investigate the association between smoking and malignancy development.

Main Methods:

  • Retrospective analysis of 104 out of 380 cardiac transplant recipients with positive cotinine levels (>500 ng/mL).
  • Monitoring of urinary cotinine levels to detect active smoking.
  • Statistical analysis including univariate and time-dependent multivariate analysis.

Main Results:

  • 27.4% of patients tested positive for smoking post-transplant, with 15.0% testing positive repeatedly.
  • Smokers had higher mortality from GCAD (21.2% vs. 12.3%) and malignancy (16.3% vs. 5.8%).
  • Post-transplant smoking significantly reduced median survival from 16.28 to 11.89 years and was the strongest predictor of mortality.

Conclusions:

  • Tobacco smoking post-cardiac transplantation detrimentally affects survival.
  • Smoking accelerates graft vasculopathy and increases cancer risk in heart transplant recipients.
  • Enhanced smoking cessation interventions are crucial for improving long-term outcomes.