Ohiomoba R O, Youmans Q R, Akanyirige P W, Ezema A U, Anderson A S, Bryant A, Jackson K, Mandieka E, Pham D T, Raza Y, Rich J D, Yancy C W, Okwuosa I S
Northwestern University, Feinberg School of Medicine, United States.
Northwestern University, Division of Cardiology, United States.
Int J Cardiol Heart Vasc. 2020 Aug 1;30:100599. doi: 10.1016/j.ijcha.2020.100599. eCollection 2020 Oct.
Active cigarette smoking (CS) is a contraindication for Orthotopic Heart Transplantation (OHT) with a recommendation that HT candidates be free from CS for at minimum 6 months prior to HT. Animal studies have shown that a history of CS is associated with increased risk of allograft rejection, but few studies have examined the association of past CS and HT outcomes. Data were analyzed from HT recipients captured in the United Network for Organ Sharing (UNOS) transplant registry. Adults aged 18-79 who underwent HT from 1987 to 2018 and with data for all covariates (N = 32,260) were included in this study. The cohort was categorized by past smoking history (CS vs non-CS). Post-transplant outcomes of interest included survival, graft failure, treated rejection, malignancy and hospitalization for infection. Baseline characteristics were compared between the two groups using the chi-squared analysis. Unadjusted associations between CS and patient survival were determined using the Kaplan-Meier estimations and confounding was addressed using multivariable Cox proportional hazards models. HT recipients with a history of CS were older (55 vs 50, p = <0.0001), more likely to be Caucasian (75.7 vs 62.3, p = <0.0001), male (81.7 vs 68.2, p =< 0.0001), and diabetic (27.4 vs 24.4, p =< 0.0001). CS was associated with significantly worse survival (HR: 1.23, p < 0.0001). A history of CS was also associated with increased risk of acute rejection (OR: 1.20, p < 0.0001), hospitalization for infection (OR:1.24, p < 0.0001), graft failure (OR:1.23, p < 0.0001) and post-transplant malignancy (OR:1.43, p < 0.0001). A history of CS is associated with increased risk of adverse events post OHT.
主动吸烟是原位心脏移植（OHT）的禁忌证，建议心脏移植候选人在移植前至少6个月戒烟。动物研究表明，吸烟史与同种异体移植排斥反应风险增加有关，但很少有研究探讨既往吸烟与心脏移植结果之间的关联。 分析了器官共享联合网络（UNOS）移植登记处记录的心脏移植受者的数据。本研究纳入了1987年至2018年间接受心脏移植且有所有协变量数据的18至79岁成年人（N = 32,260）。根据既往吸烟史（吸烟与不吸烟）对队列进行分类。感兴趣的移植后结果包括生存率、移植物功能衰竭、治疗的排斥反应、恶性肿瘤和感染住院情况。使用卡方分析比较两组的基线特征。使用Kaplan-Meier估计法确定吸烟与患者生存率之间的未调整关联，并使用多变量Cox比例风险模型处理混杂因素。 有吸烟史的心脏移植受者年龄更大（55岁对50岁，p = <0.0001），更可能是白种人（75.7%对62.3%，p = <0.0001），男性（81.7%对68.2%，p =< 0.0001），且患有糖尿病（27.4%对24.4%，p =< 0.0001）。吸烟与显著更差的生存率相关（HR：1.23，p < 0.0001）。吸烟史还与急性排斥反应风险增加（OR：1.20，p < 0.0001）、感染住院（OR：1.24，p < 0.0001）、移植物功能衰竭（OR：1.23，p < 0.0001）和移植后恶性肿瘤（OR：1.43，p < 0.0001）相关。 吸烟史与心脏移植术后不良事件风险增加有关。
