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Cigarette smoking following lung transplantation: effects on allograft function and recipient functional performance
Gerene S Bauldoff1, Christopher H Holloman, Staci Carter
1The Ohio State University College of Nursing (Dr Bauldoff), The Ohio State University Statistical Consulting Service (Dr Holloman), Wexner Medical Center, The Ohio State University (Ms Carter), and Pulmonary, Allergy, Critical Care and Sleep Medicine, The Ohio State University College of Medicine (Dr Pope-Harman), Columbus; and Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville College of Medicine, Louisville, Kentucky (Dr Nunley).
Purpose:
Despite mandatory tobacco abstinence following lung transplantation (LTX), some recipients resume smoking cigarettes. The effect of smoking on allograft function, exercise performance, and symptomatology is unknown.
Methods:
A retrospective review was conducted of LTX recipients who received allografts over an 8-year interval and who were subjected to sequential posttransplant pulmonary function testing (PFT), 6-minute walk (6MW) testing, and assessments of exertional dyspnea (Borg score). Using post-LTX PFT results, recipients were determined to have either bronchiolitis obliterans syndrome (BOS), a manifestation of chronic allograft rejection, or normal pulmonary function (non-BOS). With respect to post-LTX pulmonary function, 6MW distances, and Borg scores, comparisons were made between these recipient groups and those who resumed smoking.
Results:
Of 34 LTX recipients identified, 13 maintained normal lung function (non-BOS), while 16 demonstrated a decline in their PFT values consistent with BOS. Five recipients began smoking at median postoperative day 365 and smoked 1 pack per day for a mean of 485.6 days. Smokers developed a deterioration of their PFT values that was similar to those with BOS (P = .47) and tended to be worse than those in the non-BOS group (P = .09). All smokers experienced a decline in 6MW distances similar to those with BOS and non-BOS but reported less exertional dyspnea (lower Borg scores) than those with BOS.
Conclusion:
Recipients of LTX who resume cigarette smoking demonstrate a decline in pulmonary function similar to those afflicted with chronic allograft rejection but do not experience a decrement in their functional performance or increased dyspnea.
