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Correlates and Outcomes of Posttransplant Smoking in Solid Organ Transplant Recipients: A Systematic Literature Review and Meta-Analysis

Duerinckx, Nathalie MSN; Burkhalter, Hanna PhD, RN; Engberg, Sandra J. PhD, RN; Kirsch, Monika PhD, RN; Klem, Mary-Lou PhD, MLIS; Sereika, Susan M. PhD, MPH; De Simone, Paolo MD, PhD; De Geest, Sabina PhD, RN, FRCN; Dobbels, Fabienne PhD, Mscfor the B-SERIOUS consortium

doi: 10.1097/TP.0000000000001335
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Background Despite smoking being an absolute or relative contraindication for transplantation, about 11% to 40% of all patients continue or resume smoking posttransplant. This systematic review with meta-analysis investigated the correlates and outcomes associated with smoking after solid organ transplantation.

Methods We searched PubMed, EMBASE, CINAHL, and PsycINFO from inception until January 2016, using state-of-the art methodology. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were computed for correlates/outcomes investigated 5 times or more.

Results Seventy-three studies (43 in kidney, 17 in heart, 12 in liver, 1 in lung transplantation) investigated 95 correlates and 24 outcomes, of which 6 correlates and 4 outcomes could be included in the meta-analysis. The odds of smoking posttransplant were 1.33 times higher in men (95% CI, 1.12-1.57). Older individuals were significantly less likely to smoke (OR, 0.48; 95% CI, 0.38-0.62), as were patients with a higher body mass index (OR, 0.68; 95% CI, 0.52-0.89). Hypertension (OR, 1.16; 95% CI, 0.77-1.75), diabetes mellitus (OR, 0.52; 95% CI, 0.15-1.78), and having a history of cardiovascular disease (OR, 0.92; 95% CI, 0.77-1.09) were not significant correlates. Posttransplant smokers had higher odds of newly developed posttransplant cardiovascular disease (OR, 1.41; 95% CI, 1.02-1.95), nonskin malignancies (OR, 2.58; 95% CI, 1.26-5.29), a shorter patient survival time (OR, 0.59; 95% CI, 0.44-0.79), and higher odds of mortality (OR, 1.74; 95% CI, 1.21-2.48).

Conclusions Posttransplant smoking is associated with poor outcomes. Our results might help clinicians to understand which patients are more likely to smoke posttransplant, guide interventional approaches, and provide recommendations for future research.

In this systematic review with meta-analysis, the authors confirmthe deleterious consequences of posttransplantation smoking and bring new insights into who is smoking which could have useful consequences for transplant phsycians in their current practice.

1 Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Belgium.

2 Heart Transplantation Program, University Hospitals of Leuven, Belgium.

3 Centre of Sleep Medicine, Hirslanden Group Zürich, Switzerland.

4 School of Nursing, University of Pittsburgh, Pittsburgh, PA.

5 Department of Anesthesiology, University Hospital of Basel, Switzerland.

6 Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA.

7 Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy.

8 Institute of Nursing Science, University of Basel, Switzerland.

Received 9 December 2015. Revision received 27 April 2016.

Accepted 13 May 2016.

The research has received funding for a consortium meeting from the Brocher Foundation (a Swiss non-profit private foundation).

The authors declare no conflicts of interest.

N.D., H.B., M.K., and S.J.E. participated in the research design, performance of the research, data analysis, and writing of the article. M.L.K. participated in the research design, performance of the research, and reviewing of the article. S.M.S. participated in the research design, data analysis, and reviewing of the article. P.D.S. participated in the research design and reviewing of the article. S.D.G. participated in the research design, performance of the research, and reviewing of the article. F.D. participated in the research design, performance of the research, data analysis, and reviewing of the article. All authors agreed to publish the article.

Systematic review registration: PROSPERO registration number CRD42015003333.

Correspondence: Sabina De Geest, PhD, RN, FRCN, Institute of Nursing Science, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland. (

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