Cigarette Smoking Effect on Survival After Lung Transplant in Cystic Fibrosis

Objectives: The effect of prior cigarette use by lung transplant donors and recipients on posttransplant survival is poorly defined, especially in subjects with cystic fibrosis. We sought to determine if donor or recipient cigarette smoking is associated with differential postlung transplant outcomes in cystic fibrosis patients, including survival. Materials and Methods: The United Network for Organ Sharing database was searched to analyze a large sample of cystic fibrosis patients with a history of lung transplant. The primary endpoint of the study was overall survival after transplant based on either recipient or donor history of smoking cigarettes. Results: There was a significant decrease in survival for cystic fibrosis patients who received lungs from a donor with a history of smoking (P=.026), but no difference in survival for recipients with a personal history of smoking. Nearly 60% of subjects who received lungs from a smoking donor died during the study. Donor smoking history was correlated with survival in a univariate (HR 1.2, [1.04-1.3]), but not multivariate model. Donor smoking history also was associated with increased treatment for rejection within the first year after transplant (P=.005). Conclusions: More than 20 pack-year history of donor smoking may affect lung transplant outcomes (eg, survival and acute rejection) in patients with cystic fibrosis. Caution must be exercised when choosing suitable organ donors for cystic fibrosis patients requiring a lung transplant.