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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Int+J+Nephrol+Renovasc+Dis
2018 ; 11
(ä): 155-164
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Smoking and outcomes in kidney transplant recipients: a post hoc survival
analysis of the FAVORIT trial
#MMPMID29760559
Weinrauch LA
; Claggett B
; Liu J
; Finn PV
; Weir MR
; Weiner DE
; D'Elia JA
Int J Nephrol Renovasc Dis
2018[]; 11
(ä): 155-164
PMID29760559
show ga
BACKGROUND: Tobacco use remains an international health problem with between 10%
and 40% of adults currently using tobacco. Given the rising number of patients
either awaiting or having received a kidney transplant and the absence of smoking
cessation as the criterion for transplantation in guidelines, we explored the
association between smoking status and clinical outcomes in kidney transplant
recipients. PATIENTS AND METHODS: In this post hoc analysis of the Folic Acid for
Vascular Outcome Reduction in Transplant trial, the associations between smoking
status, defined as never having smoked, formerly or currently smoking, and both
all-cause mortality and graft survival were assessed using Cox proportional
hazards models. Fatal events were centrally adjudicated into prespecified
categories: all-cause, cardiovascular and non-cardiovascular causes. Graft loss
was defined as return to dialysis or retransplantation. Clinical Trials URL:
http://www.clinicaltrials.gov/show/NCT00064753. RESULTS: Among 4110 transplant
recipients, there were 451 current smokers and 1611 former smokers. The mortality
rate per 100 patient-years was 4.0 (71 deaths) for smokers, 3.5 (226 deaths) for
former smokers and 2.4 (116 deaths) for never smokers. Hazard ratio for mortality
for current smokers was 1.70 (CI=1.26-2.29, p=0.001) and for former smokers was
1.21 (0.98-1.50, p=0.08) with 1.0 representing never smokers. As the number of
cardiovascular deaths was similar in each group (all p>0.3), the differences
between groups was driven by non-cardiovascular death rates. Current smokers
(2.39; 1.62-3.61, p<0.001) and former smokers (1.50; 1.12-2.01, p=0.007) had
increased hazard of non-cardiovascular death. Kidney allograft failure was more
likely in current smokers than in either former or never smokers (3.5, 2.1 and
2.0 per 100 patient-years, p<0.001, adjusted hazard ratio 1.49 and 1.05,
respectively). CONCLUSION: Continued smoking was associated with >100% increased
risk of non-cardiovascular death, 70% greater risk of all-cause mortality and a
50% greater risk of graft loss, a risk not seen in former smokers. These findings
confirm previous non-adjudicated observations that smoking is associated with
adverse clinical outcomes and suggest that more emphasis should be placed on
smoking cessation prior to kidney transplantation.