Excess risk of renal allograft loss associated with cigarette smoking

Background, Cigarette smoking contributes to a number of health-related pro blems, but its impact on renal transplant survival beyond accelerated patie nt death is unclear. Methods. We performed a cohort study of 645 adult renal allograft recipient s from 1985 to 1995 to evaluate the relationship between smoking and graft outcome. Results. Twenty-four percent of recipients (156/645) were smokers at the ti me of transplant evaluation. Of these, 90% continued to smoke after transpl antation. Pretransplant smoking was significantly associated with reduced o verall graft and death-censored graft survival. Patients who were smokers a t the time of pretransplant evaluation had kidney graft survival of 84%, 65 %, and 48% at 1, 5, and 10 years, respectively, compared with graft surviva l in nonsmokers of 88%, 78%, and 62% (P=0.007). Pretransplant smoking adver sely affected death-censored graft survival in recipients of cadaveric (P=0 .02) and of living donor kidneys (P=0.02). Reduced graft survival in pretra nsplant smokers could not be accounted for by differences in rejection (64% vs. 61%, P=0.35). In a multivariate analysis, pretransplant smoking was as sociated with a relative risk of 2.3 for graft loss. Among patients with a smoking history before transplantation, death-censored graft survival was s ignificantly higher for those who quit smoking before transplant evaluation . Conclusions, Cigarette smoking before kidney transplantation contributes si gnificantly to allograft loss. The effect of smoking on graft outcome is no t explained by increases in rejection or patient death. Smoking cessation b efore renal transplantation has beneficial effects on graft survival. These effects should be emphasized to patients with end-stage renal disease who are considering renal transplantation.