History of Cigarette Smoking and Heart Transplant Outcomes

Objective The deleterious effects of cigarette smoking (CS) have been well documented. Active cigarette use is a relative contraindication for heart transplantation (HT) with a recommendation that candidates be abstinent for at least 6 months prior to HT. Animal studies have shown that a history of CS is associated with increased risk of allograft rejection. Our study examines the association of CS history and HT outcomes. Methods Data were analyzed from HT recipients captured in the United Network for Organ Sharing (UNOS) transplant registry. Included in this study were adults who underwent HT from 1987 to 2018 and who had available smoking status data (N= 38,220). The cohort was categorized by smoking status (CS vs non-CS). Post-transplant outcomes of interest included survival, graft failure, treated hospitalizations and hospitalizations for infection. Baseline characteristics were compared between the two groups using chi-squared analysis. Unadjusted associations between CS and patient survival were determined using Kaplan-Meier estimations and confounding was addressed using multivariable Cox proportional hazards models. Results HT recipients with a history of CS were older (55 vs 50, p= Conclusions A history of CS was associated with increased risk for acute rejection, hospitalization for infection, graft failure, post-transplant malignancy and worse survival. A history of CS should be considered in post HT management.