title: Analysis of smoking in patients referred for liver transplantation and its adverse impact of short-term outcomes.
abstract: Smoking has been reported to adversely affect the outcome of patients undergoing liver transplantation (LT). We present a clinical and demographic analysis of smoking in patients from a rural Appalachian region referred to our center for LT. We reviewed 237 consecutive patients referred for LT between January 2002 and December 2003. We also reviewed charts of 65 patients that underwent LT at our center during this period and analyzed the length of stay (LOS), one-year survival post LT, and hospital charge information. The mean MELD score was similar between smokers and nonsmokers at the time of referral (12.3 vs. 12.1, respectively, p = 0.8). Smokers had a tendency towards a higher CPT score (8.2 vs. 7.9, p = 0.06). The incidence of difficult-to-manage ascites and encephalopathy was significantly higher in smokers (p < 0.O1 for both ascites and encephalopathy). Of the 65 patients that underwent LT, 69.2% were smokers. While one-year post LT survival was similar (approximately 90%) for both smokers and nonsmokers, the mean length of stay and hospital charge for smokers was significantly higher (13.4 vs. 7.9 days; P = .02 and $129,185 vs. $99,694; P = .02). In conclusion, smokers have a higher incidence of ascites and encephalopathy and thus may be disadvantaged by the MELD allocation scheme for liver transplantation. While post-transplant one-year survival is similar between smokers and nonsmokers, smokers have higher LOS and resource utilization.
authors.affiliation: University of Kentucky Transplant Surgery, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: McConathy
authors.forename: Vicky
authors.initials: V
authors.lastname: Turner
authors.forename: Thomas
authors.initials: T
authors.lastname: Johnston
authors.forename: Hoonbae
authors.initials: H
authors.lastname: Jeon
authors.forename: Illiana
authors.initials: I
authors.lastname: Bouneva
authors.forename: Alvaro
authors.initials: A
authors.lastname: Koch
authors.forename: Timothy
authors.initials: T
authors.lastname: Clifford
authors.forename: Dinesh
authors.initials: D
authors.lastname: Ranjan
mesh_terms: D001201:Ascites / Q000453:epidemiology / Q000209:etiology; D006295:Health Resources / Q000706:statistics & numerical data*; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D007902:Length of Stay; D016031:Liver Transplantation / Q000191:economics* / Q000401:mortality; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects* / Q000191:economics / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome