DiMartini Andrea, Javed Lubna, Russell Sarah, Dew Mary Amanda, Fitzgerald Mary Grace, Jain Ashok, Fung John
Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Liver Transpl. 2005 Jun;11(6):679-83. doi: 10.1002/lt.20385.
Alcohol and tobacco use commonly co-occur, with at least 90% of those with an alcohol problem also using tobacco. Thus, 3 years ago when we discovered higher rate of late deaths due to lung and oropharyngeal cancer in patients who had received a transplant for alcoholic liver disease (ALD), we hypothesized that these patients were continuing to expose themselves to tobacco after liver transplantation (post-LTX) and that this behavior was increasing their risk for cancer. We subsequently began a prospective investigation of post-LTX tobacco use in patients having undergone LTX for ALD (n = 172). For 33 recipients we had data starting from our first assessment at 3 months post-LTX and for this subgroup we report on the details of the timing of tobacco use resumption and the redevelopment of nicotine addiction. We found that on average more than 40% are smoking across all time periods. ALD recipients resume smoking early post-LTX, increase their consumption over time, and quickly become tobacco dependent. These data highlight an underrecognized serious health risk for these patients and demonstrate our need for more stringent clinical monitoring and intervention for tobacco use in the pre- and post-LTX periods.
酒精和烟草的使用常常同时出现，至少90%有酒精问题的人也使用烟草。因此，3年前当我们发现因酒精性肝病（ALD）接受移植的患者中，肺癌和口咽癌导致的晚期死亡率较高时，我们推测这些患者在肝移植后（LTX后）仍继续接触烟草，并且这种行为增加了他们患癌症的风险。随后，我们对因ALD接受LTX的患者（n = 172）的LTX后烟草使用情况进行了前瞻性调查。对于33名受者，我们有从LTX后3个月首次评估开始的数据，对于这个亚组，我们报告了恢复烟草使用的时间细节以及尼古丁成瘾的重新形成情况。我们发现，在所有时间段平均有超过40%的人吸烟。ALD受者在LTX后早期就恢复吸烟，随着时间的推移吸烟量增加，并很快对烟草产生依赖。这些数据凸显了这些患者中一种未得到充分认识的严重健康风险，并表明我们需要在LTX前后对烟草使用进行更严格的临床监测和干预。
