Is Donor Smoking Truly a Risk Factor for the Development of Cardiac Allograft Vasculopathy?

Abstract

<h3>Purpose</h3> Smoking in the potential donor may be a risk factor for the development of cardiac allograft vasculopathy (CAV) following heart transplantation. It has been demonstrated by Loupy and colleagues using the cardiac iBox that donor smoking was an independent factor leading to a high trajectory for developing CAV by coronary angiography. It has not been well established how much donor smoking attributes to this problem. Therefore, we reviewed our experience with donors and their smoking history to assess this post-transplant complication. <h3>Methods</h3> Between 2010 and 2017, we assessed 678 donors whose heart underwent heart transplantation. Donors were separated into those with smoking history >20 pack-years and continued cigarette use in the past 6 months (data provided from UNOS). Each group was assessed for 1-, 2-, 3-year survival and freedom from the development of coronary angiography-proven evidence of CAV (defined as coronary lesion ≥30% stenosis). This study group was compared to a control group with no donor smoking history. <h3>Results</h3> Donors with a current 20 pack-year smoking history compared to those donors without smoking had a trend for an increased risk for the development of CAV on coronary angiography over 3 years. 1-, 2-, 3-year survival was similar in both groups. <h3>Conclusion</h3> Active donor smoking history appears to be a potential risk factor for the development of CAV. Longer follow-up is needed to further define this risk.