title: Tobacco use following liver transplantation for alcoholic liver disease: an underestimated problem.
abstract: 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.
authors.affiliation: Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. dimartiniaf@upmc.edu
authors.forename: Andrea
authors.initials: A
authors.lastname: DiMartini
authors.forename: Lubna
authors.initials: L
authors.lastname: Javed
authors.forename: Sarah
authors.initials: S
authors.lastname: Russell
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Mary Grace
authors.initials: MG
authors.lastname: Fitzgerald
authors.forename: Ashok
authors.initials: A
authors.lastname: Jain
authors.forename: John
authors.initials: J
authors.lastname: Fung
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001294:Attitude to Health; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D008108:Liver Diseases, Alcoholic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D015995:Prevalence; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012309:Risk-Taking; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*; D015996:Survival Rate