A large US study reveals increased rates of organ failure and acute rejection when kidney donors have a history of cigarette use.
RT’s Three Key Takeaways
- Elevated Transplant Complications: Patients who receive kidneys from living donors with a smoking history face higher risks of graft loss and acute rejection compared with those whose donors never smoked.
- Dose-Dependent Risk: Transplant recipients of organs from donors with more than 20 pack-years of tobacco exposure encounter a 29% higher risk of graft loss, a 24% higher risk of delayed graft function, and a 32% higher risk of acute rejection.
- Cessation Considerations: Organs from former smokers perform better than those from active smokers, suggesting that tobacco cessation prior to donation may help mitigate adverse post-transplant outcomes.
Patients who receive a kidney from a living donor with a history of cigarette smoking face an increased risk of transplant failure, according to a study conducted by UC Davis Health researchers and published in Kidney360.
The investigation evaluated national registry data from 88,490 living donor kidney transplant recipients in the US between 2004 and 2022 using the Organ Procurement and Transplantation Network (OPTN) database. According to the study, recipients of kidneys from donors with any documented history of smoking experienced a 13% higher risk of all-cause graft loss compared to recipients whose donors never smoked. Furthermore, donor smoking history correlated with an 18% increase in the odds of acute rejection during the first year following transplantation.
Substantial Smoking Exposure Escalates Risk
The data indicated that complications were most pronounced among recipients whose donors had heavy tobacco exposure, defined as more than 20 pack-years. A pack-year equals smoking one pack of cigarettes per day for an entire year.
According to study findings, recipients receiving kidneys from donors with more than 20 pack-years faced a 29% higher risk of graft loss, a 24% higher risk of delayed graft function, and a 32% higher risk of acute rejection compared to recipients of organs from non-smokers.
“Our findings suggest that smoking history, particularly heavy smoking exposure, should be considered during living donor evaluation and counseling,” said Machi Kaneko McBee, pediatric nephrologist and lead author of the study, in a news release. “At the same time, living donor transplantation remains a highly beneficial treatment option and smoking history alone should not automatically disqualify an otherwise suitable donor.”
Implications for Clinical Evaluation and Cessation
The analysis also demonstrated differences based on donor smoking status at the time of donation. Kidneys from former smokers performed better than those from active smokers, indicating that tobacco cessation prior to donation may reduce post-transplant complications, according to the researchers. However, the overall duration of smoking abstinence did not significantly alter long-term graft survival outcomes.
The study co-authors include Daniel Tancredi and Lavjay Butani of UC Davis Health. The authors noted that these findings highlight the necessity of incorporating detailed donor smoking histories into living donor evaluations across healthcare institutions to better inform risk stratification and patient counseling.
