There is No Smoking Gun: LongTerm Lung Transplant (LTx) Outcomes Using Smoking Donors

Abstract

<h3>Purpose</h3> Lung transplant (LTx) is limited by a supply of donor lungs. Donor lungs from smokers are known to have adverse effects on early post-LTx outcomes (Oto et al, 2004). As long-term survival outcomes remains under assessed we investigated the effect of donor smoking on long-term LTx survival and death from chronic lung allograft dysfunction (CLAD) using the cohort described by Oto et al. <h3>Methods</h3> 173 bilateral LTx recipient records between 1995-2002 were retrospectively reviewed. 97 (56.1%) of LTx donors had ceased or never smoked and 76 (43.9%) were current smokers. Kaplan-Meir models were used to assess long-term survival. Smoking donors were divided into two groups: 1-15 pack years (PY) (n=35) and >16 PY (n=21). 20 recipients received donors with a smoking history but unknown amount. Hazard ratios (HR) were used to assess survival outcomes between known smoking groups. <h3>Results</h3> No significant survival difference was found between LTx recipients for never/ ceased smokers and smokers (Figure 1) or between smoking dose cohorts (Figure 2). HR for smokers compared to never/ ceased smokers: 1.25, 95% CI 0.70 to 2.25, p=0.439. HR for 1-15 PY compared to never or ceased smokers: 1.21, 95% CI 0.57 to 2.53, p=0.615. HR for >16 PY compared to never/ ceased smokers: 0.83, 95% CI 0.28 to 2.41, p=0.721. There was no significant difference in death from CLAD between groups. <h3>Conclusion</h3> This study suggests that a smoking history in LTx donors does not significantly affect long-term survival or increase death from CLAD. This may have implications for expanding donor criteria, enabling LTx opportunities for more patients.