Impact of Cigarette Smoking on Heart Transplant Outcomes: A Review

Heart transplantation is a life-saving procedure for patients with end-stage heart failure, but long-term success is influenced by multiple factors, including smoking. Smoking has been associated with negative cardiovascular outcomes in both the general population and transplant recipients. This review examines the impact of smoking on heart transplant outcomes, focusing on donor smoking history, pretransplant smoking in recipients, and posttransplant smoking relapse. A literature review was conducted using PubMed and Google Scholar-indexed articles that analyzed smoking and heart transplantation. Studies evaluating donor smoking history, recipient smoking history before transplantation, and posttransplant smoking relapse were included and assessed for the impact of smoking on heart transplant outcomes. Findings demonstrated that donor smoking history negatively impacted long-term survival and graft failure rates. Pretransplant smoking history in recipients was linked to higher rates of acute rejection, infections requiring hospitalization, malignancy, and worse survival. Posttransplant smoking relapse was associated with higher rates of graft coronary artery disease and malignancy and was the strongest predictor of mortality. Smoking in both donors and recipients is associated with worse heart transplant outcomes, and more aggressive smoking cessation interventions, pre- and post-transplant, are necessary to mitigate these risks and improve transplant success rates.