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 The review of studies on solid organ transplant patients found that
more than 10 percent resume smoking after the operation. These
smokers have more than 2.5 times the risk of nonskin cancers
compared to transplant recipients who don’t smoke, and elevated
risks of new heart disease as well as death.
Transplant patients must remain on immunosuppressive medication for
life to keep their bodies from rejecting the organ, which is why
they already have an increased risk of cancer, infections and heart
disease, researchers write in the journal Transplantation.
“In transplantation, smoking clearly has a negative impact, an even
bigger impact than if you are a nontransplant person,” said coauthor
Sabina De Geest of the University of Basel in Switzerland.
The researchers reviewed 73 studies of transplantation, most
focusing on kidney, heart or lung transplants, and they analyzed
data on six potential risk factors before surgery and four outcomes
after surgery.
Men were 30 percent more likely to smoke after a transplant than
women, and younger, thinner people were also more likely to smoke
than others.
Those who continued or resumed smoking after a transplant were 40
percent more likely than others to develop new heart disease, 2.58
times more likely to develop a malignancy other than skin cancer and
1.74 times more likely to die during the follow-up period.
International consensus guidelines say that active tobacco smoking
or smoking within the previous six months should be a disqualifying
factor for a patient who needs a heart or lung transplant, and
strongly recommend quitting before a kidney or liver transplant.
“Most transplant programs are really targeted to providing patients
this information, before you have a transplant you go through an
evaluation program,” De Geest told Reuters Health.
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But assessing smoking status and other health risk factors should be
an ongoing process, she said, before, during and after
transplantation, as long as 10 to 15 years after the transplant
happens. Staying active and eating healthy are also important after
a transplant, she said.
“It’s a non-sexy part of transplantation, but it should be
integrated throughout the transplantation continuum,” De Geest said.
“Smoking is clearly a modifiable risk factor that has a negative
impact on transplant outcome,” said Dr. Chris Dudley of Southmead
Hospital in Bristol, UK, who was not part of the new review.
Smoking may also be a surrogate for socioeconomic status: poorer,
less educated people are more likely to smoke and also tend to have
worse health outcomes, he told Reuters Health.
“One of the questions is, should we ration transplantation to
nonsmokers only, but I don’t think that’s feasible,” Dudley said.
“We live in a liberal democracy, for the most part, and that would
be thought of as too draconian.”
Some patient will quit, or claim to quit, before a transplant and
resume smoking after, he said.
SOURCE: http://bit.ly/2c0alse Transplantation, online July 29, 2016.
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