Smoking behavior in liver transplant recipients

Area of Science:

• Hepatology
• Transplantation Medicine
• Oncology

Background:

• Cardiovascular disease and cancer significantly impact long-term outcomes after orthotopic liver transplantation (OLT).
• Tobacco use is a known risk factor for both cancer and cardiovascular disease.

Purpose of the Study:

• To investigate smoking behaviors before and after OLT.
• To identify patient groups at risk for resuming smoking post-OLT.
• To explore the association between smoking and post-OLT morbidity.

Main Methods:

• Retrospective chart review of 401 adult OLT patients with ≥2 years follow-up.
• A smoking habit questionnaire was administered to 326 surviving patients, with a 92% response rate.
• Smoking status was assessed at four time points: pre-OLT evaluation and post-OLT follow-up.

Main Results:

• Pre- and post-OLT, 53% of patients were never smokers and 17% were active smokers.
• Nearly one-third of active smokers successfully quit during OLT evaluation; 12% of former smokers relapsed, primarily post-OLT.
• Tobacco use was highest in alcoholic liver disease patients (52% pre-OLT, 44% post-OLT) and lowest in primary sclerosing cholangitis patients (1.4% pre-OLT).
• At 10 years, cumulative malignancy rates were 12.7% in active smokers versus 2.1% in non-smokers (P=0.019).
• No significant impact on skin cancer or cardiovascular disease was observed.

Conclusions:

• Smoking is a significant issue post-OLT, elevating malignancy risk.
• Prevention programs should target both active and former smokers to mitigate long-term health risks.