Abstract
168 Cigarette smoking contributes to a number of health-related problems, including atherosclerosis and cancer, but the impact of smoking on renal transplant outcome is not known. Methods: Complete records from 645 adult renal allograft recipients from 1986-1995 were retrospectively reviewed for smoking history and graft outcome. Patients were assigned to two groups based on smoking at any time from initial evaluation to date of transplant. Kaplan-Meier survival estimates for graft survival, death-censored graft survival, and patient survival were compared using the logrank test. Follow-up ranged from 2-12 years. A proportional hazards model determined independent risk factors for graft loss and patient death. Results: Fifty-two percent of recipients reported a history of smoking. One hundred fifty-six of 645 (24%) were smoking between the time of evaluation and transplant, and this group had significantly reduced overall graft and death-censored graft survival. (Table)TablePre-transplant smoking adversely affected death-censored graft survival in recipients of both cadaveric (p=0.02) and living donor kidneys (p=0.02). Reduced graft survival in the smoking group could not be accounted for by differences in rejection (64% vs. 61%, p=ns). In the proportional hazards model, pre-transplant smoking was a more significant independent risk factor for both graft loss (RR = 9.1) and death-censored graft loss (RR=15.4) than age (RR= ns and 1.03/year), diabetes (RR=1.07 and ns), dialysis duration (RR= 1.09/year and 1.1/year), rejection (RR= 4.2 and 5.4), and cadaver donor (RR= 1.4 and ns). Conclusions: Cigarette smoking prior to kidney transplantation contributes to kidney allograft loss. The adverse effect of smoking on graft outcome is not explained by increases in rejection or patient death, and is a more important prognostic factor than age, diabetes, or donor source for graft loss. These effects should be emphasized to patients considering renal transplantation.
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