The Impact of Donor Smoking on Primary Graft Dysfunction and Mortality after Lung Transplantation
Year: 2023
Type: article
Study design: Observational Study
Abstract: Rationale Primary graft dysfunction (PGD) is the leading cause of early morbidity and mortality after lung transplantation. Prior studies implicated proxy-defined donor smoking as a risk factor for PGD and mortality. Objectives We aimed to more accurately assess the impact of donor smoke exposure on PGD and mortality using quantitative smoke exposure biomarkers. Methods We performed a multicenter prospective cohort study of lung transplant recipients enrolled in the Lung Transplant Outcomes Group cohort between 2012 and 2018. PGD was defined as grade 3 at 48 or 72 hours after lung reperfusion. Donor smoking was defined using accepted thresholds of urinary biomarkers of nicotine exposure (cotinine) and tobacco-specific nitrosamine (4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol [NNAL]) in addition to clinical history. The donor smoking–PGD association was assessed using logistic regression, and survival analysis was performed using inverse probability of exposure weighting according to smoking category. Measurements and Main Results Active donor smoking prevalence varied by definition, with 34–43% based on urinary cotinine, 28% by urinary NNAL, and 37% by clinical documentation. The standardized risk of PGD associated with active donor smoking was higher across all definitions, with an absolute risk increase of 11.5% (95% confidence interval [CI], 3.8% to 19.2%) by urinary cotinine, 5.7% (95% CI, −3.4% to 14.9%) by urinary NNAL, and 6.5% (95% CI, −2.8% to 15.8%) defined clinically. Donor smoking was not associated with differential post–lung transplant survival using any definition. Conclusions Donor smoking associates with a modest increase in PGD risk but not with increased recipient mortality. Use of lungs from smokers is likely safe and may increase lung donor availability. Clinical trial registered with www.clinicaltrials.gov (NCT00552357).
Authors: Joshua M. Diamond, Edward Cantu, Carolyn S. Calfee, Michaela R. Anderson, Emily S. Clausen, Michael G. S. Shashaty, Andrew M. Courtwright, Laurel Kalman, Michelle Oyster, Maria M. Crespo, Christian A. Bermudez, Luke Benvenuto, Scott M. Palmer, Laurie D. Snyder, Matthew G. Hartwig, Jamie L. Todd, Keith Wille, Chadi Hage, John F. McDyer, Christian A. Merlo, Pali D. Shah, Jonathan B. Orens, Gundeep S. Dhillon, Ann B. Weinacker, Vibha N. Lama, Mrunal G. Patel, Jonathan P. Singer, Jesse Hsu, A. Russell Localio, Jason D. Christie
Institutions: University of Pennsylvania, University of California, San Francisco, Columbia University Irving Medical Center, Columbia University, Duke University, Duke Medical Center, University of Alabama at Birmingham, University of Pittsburgh, Johns Hopkins University, Johns Hopkins Medicine, Johns Hopkins Hospital, Stanford Medicine, University of Michigan, Michigan Medicine, Indiana University Indianapolis, Indiana University School of Medicine
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4386915512