RISK FACTORS OF SMOKING AFTER HEART TRANSPLANTATION
DOI:
https://doi.org/10.32553/ijmbs.v4i10.1483Keywords:
heart transplantation, Cardiac allograft vasculopathy, smoking, malignancyAbstract
While cessation of smoking is a requirement for cardiac transplantation prior to listing, some patients return to smoking after recovery. Since 1993, we have covertly tested the smoking habits of our recipients of cardiac transplants (with ethical approval) by calculating urinary cotinine: a level of > 500 ng / mL suggesting continuing tobacco use. Survival, causes of death and the occurrence of graft coronary artery disease (GCAD) were retrospectively analyzed in terms of the amount of positive and negative levels of cotinine. At some point after transplantation, one hundred and four out of 380 (27.4 percent) patients tested positive for active smoking, and 57 (15.0 percent) tested positive repeatedly. Because of GCAD (21.2 percent vs. 12.3 percent, p<0.05), and because of malignancy (16.3 percent vs. 5.8 percent, p<0.001), smokers experienced slightly more deaths. Smoking after heart transplantation reduced median survival from 16.28 years to 11.89 years in the univariate study. After accounting for the impact of pretransplant smoking in a time-dependent multivariate study, the most relevant determinant of total mortality remained posttransplant smoking (p < 0.00001). We conclude that by accelerating the production of graft vasculopathy and malignancy, cigarette smoking after cardiac transplantation has a substantial effect on survival. We hope that this information will prevent recipients of cardiac transplants from relapsing and will intensify efforts to increase the rate of cessation.
Keywords: heart transplantation, Cardiac allograft vasculopathy, smoking, malignancy
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