EFFECTS OF SMOKING ON LENGTH OF HOSPITAL STAY IN PATIENTS SURVIVING AN ORTHOTOPIC LIVER TRANSPLANT
AbstractBackground: Smoking in orthotopic liver transplant (OLT) recipients has been associated with increased risk of vascular complications, cardiac events, graft failure and oesophegeal cancer. The aim of this study was to determine the effect of smoking on length of hospital stay post OLT and also to audit support provided to these patients. Methods: This was a retrospective study carried out in the Liver Transplant Unit, St James University Hospital, UK from 1979 to 2005. One hundred seventy-four 174 adult patients who had undergone OLT in this hospital during this time with a follow-up of at least 2 years after transplantation were included. Results: One hundred seventy-four 174 patients (mean age 52.2 years) responded by answering the questionnaire. Answers were analysed using relevant statistical methods. Eighty 80 patients had a smoking history (ever-smoked) while 94 were non-smokers (never-smoked). Out of 56 patients with a smoking history, 46% (n=26) were offered advice and only 18% (n=10) were offered any support. Of the 26 patients smoking at the time of OLT, 58% (n=15) were offered advice and only 19% (n=5) had been offered support. There was no significant difference in length of hospital stay post OLT between patients who had never-smoked and ever-smoked (p=0.780). In addition, smoking at the time of OLT had no significant impact on length of hospital stay (p=0.922). Conclusions: Smoking per se does not seem to increase hospital stay post OLT. Patients should be adequately counselled about smoking post OLT. Support mechanisms, including better awareness among doctors and allied healthcare workers should be made available to tackle this problem.Keywords: smoking, orthotopic liver transplant, OLT
Lee DS, Mathur AK, Acker WB 2nd, Al-Holou SN, Ehrlichman LK, Lewin SA, et al. Effects of smoking on survival for patients with end-stage liver disease. J Am Coll Surg. 2009;208:1077–84.
Ramachandran J, John L, Juneja R, Dutta AK, Woodman R, Wigg1 AJ. Renal dysfunction post liver transplantation. J Gestroentrol Hepatol 2009;24(Suppl 2):298. [Abstract]
Rubio E, Moreno JM, Pons F, Sanchez-Turrion V, Cuervas-Mons V. De novo malignancies in liver transplantation. Transplant Proc 2003;35:1896–7.
Bowser N, Murray E, Ho V, Ali A, Macdonald G, Pre-liver transplant micronutrient status and impact on post-liver transplant outcomes J Gastroenterol Hepatol 2009;24(Suppl 2):296. [Abstract]
Herrero JI, Lorenzo M, Quiroga J, Sangro B, Pardo F, Rotellar F, et al. De novo neoplasia after liver transplantation: an analysis of risk factors and influence on survival. Liver Transpl 2005;11:89–97.
Scheifele C, Reichart PA, Hippler-Benscheidt M, Neuhaus P, Neuhaus R. Incidence of oral, pharyngeal, and laryngeal squamous cell carcinomas among 1515 patients after liver transplantation. Oral Oncol 2005;41:670–6.
Jimenez C, Manrique A, Marques E, Ortega P, Loinaz C, Gomez R, et al. Incidence and risk factors for the development of lung tumors after liver transplantation. Transpl Int 2007;20:57–63.
Pungpapong S, Manzarbeitia C, Ortiz J, Reich DJ, Araya V, Rothstein KD, et al. Cigarette smoking is associated with an increased incidence of vascular complications after liver transplant. Liver Transpl 2002;8:582–7.
Borg MA, van der Wouden EJ, Sluiter WJ, Slooff MJ, Haagsma EB, van den Berg AP. Vascular events after liver transplantation: a long-term follow-up study. Transpl Int 2008;21:74–80.
Batel P, Pessione F, Maître C, Rueff B. Relationship between alcohol and tobacco dependencies among alcoholics who smoke. Addiction 1995;90:977–80.
Tringali RA, Trzepacz PT, DiMartini A, Dew MA. Tringali, Trzepacz, Dimartini, Dew. Assessment and follow-up of alcohol dependant liver transplantation patients. Gen Hosp Psychiatry 1996;18(6 Suppl); 70S–77S.
DiMartini A, Javed L, Russell S, Dew MA, Fitzgerald MG, Jain A, et al. Tobacco use following liver transplantation for alcoholic liver disease: an underestimated problem. Liver Transpl 2005;11: 679–83.
Ehlers SL, Rodrigue JR, Widows MR, Reed AI, Nelson DR. Ehlers SL, Rodrigue JR, Widows, Reeds, Nelson. Tobacco use before and after liver transplantation, a single centre survey and implications for clinical practice and research. Liver Transpl 2004;10:412–7.