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History of cigarette smoking and heart transplant outcomes
R O Ohiomoba1, Q R Youmans2, P W Akanyirige1
1Northwestern University, Feinberg School of Medicine, United States.
Insights
Past cigarette smoking (CS) significantly increases risks after heart transplantation (HT). Patients with a history of CS experienced worse survival, higher rates of rejection, infection, graft failure, and malignancy post-transplant.
Area of Science:
- Cardiology
- Transplantation Medicine
- Public Health
Background:
- Active cigarette smoking (CS) is a contraindication for Orthotopic Heart Transplantation (OHT).
- Current guidelines recommend a minimum 6-month cessation period before HT.
- Limited research exists on the impact of past CS on HT outcomes.
Purpose of the Study:
- To investigate the association between a history of cigarette smoking (CS) and post-transplant outcomes in adult heart transplant (HT) recipients.
- To determine if prior CS impacts survival, graft failure, rejection, infection, and malignancy rates.
Main Methods:
- Analysis of data from the United Network for Organ Sharing (UNOS) transplant registry.
- Inclusion of adult HT recipients (18-79 years) from 1987-2018 (N=32,260).
- Cohort categorized by past smoking history (CS vs. non-CS); outcomes assessed using survival analysis and Cox proportional hazards models.
Main Results:
- HT recipients with a history of CS were older, more likely to be Caucasian, male, and diabetic.
- Past CS was significantly associated with worse patient survival (HR: 1.23).
- A history of CS increased the risk of acute rejection (OR: 1.20), infection hospitalization (OR: 1.24), graft failure (OR: 1.23), and post-transplant malignancy (OR: 1.43).
Conclusions:
- A history of cigarette smoking (CS) is linked to a higher risk of adverse events following Orthotopic Heart Transplantation (OHT).
- These findings suggest that a history of CS may negatively influence long-term outcomes after heart transplantation.
Abstract:
Background : Active cigarette smoking (CS) is a contraindication for Orthotopic Heart Transplantation (OHT) with a recommendation that HT candidates be free from CS for at minimum 6 months prior to HT. Animal studies have shown that a history of CS is associated with increased risk of allograft rejection, but few studies have examined the association of past CS and HT outcomes. Methods : Data were analyzed from HT recipients captured in the United Network for Organ Sharing (UNOS) transplant registry. Adults aged 18-79 who underwent HT from 1987 to 2018 and with data for all covariates (N = 32,260) were included in this study. The cohort was categorized by past smoking history (CS vs non-CS). Post-transplant outcomes of interest included survival, graft failure, treated rejection, malignancy and hospitalization for infection. Baseline characteristics were compared between the two groups using the chi-squared analysis. Unadjusted associations between CS and patient survival were determined using the Kaplan-Meier estimations and confounding was addressed using multivariable Cox proportional hazards models. Results : HT recipients with a history of CS were older (55 vs 50, p = <0.0001), more likely to be Caucasian (75.7 vs 62.3, p = <0.0001), male (81.7 vs 68.2, p =< 0.0001), and diabetic (27.4 vs 24.4, p =< 0.0001). CS was associated with significantly worse survival (HR: 1.23, p < 0.0001). A history of CS was also associated with increased risk of acute rejection (OR: 1.20, p < 0.0001), hospitalization for infection (OR:1.24, p < 0.0001), graft failure (OR:1.23, p < 0.0001) and post-transplant malignancy (OR:1.43, p < 0.0001). Conclusion : A history of CS is associated with increased risk of adverse events post OHT.
