Smoking after cardiac transplantation.

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.