Cigarette smoking, kidney function, and mortality after live donor kidney transplant

Area of Science:

• Nephrology
• Transplant Surgery
• Public Health

Background:

• Smoking is a known health risk, but its impact on kidney transplant outcomes is not well-established.
• This study investigates the association between smoking and adverse events following kidney transplantation.

Purpose of the Study:

• To assess the association of smoking with transplant survival and patient survival.
• To evaluate the impact of smoking on early rejection and graft function after kidney transplant.

Main Methods:

• Retrospective cohort study of 997 laparoscopic live donor kidney transplant recipients.
• Smoking status at the time of transplant evaluation was the primary predictor.
• Transplant survival, patient survival, rejection rates, and early graft function were key outcomes.

Main Results:

• Ever-smokers had significantly worse transplant survival (adjusted HR, 1.47) and patient survival (adjusted HR, 1.60) compared to never-smokers.
• Ever-smokers experienced substantially worse first-year rejection-free survival (adjusted HR, 1.46) and a higher risk of early rejection (adjusted HR, 1.8).
• While univariate analysis showed lower GFR and poorer early function in ever-smokers, this was not significant in multivariate analysis.

Conclusions:

• A history of smoking prior to kidney transplant is associated with poorer transplant and patient survival.
• Smoking increases the risk of early rejection in live donor kidney transplant recipients.
• Further research is needed to explore potential immunomodulatory or nephrotoxic effects of smoking in transplant patients.