title: Comparison of outcomes from smoking and nonsmoking donors: thirteen-year experience.
abstract: BACKGROUND
  Lung transplantation remains the best treatment option for a variety of end-stage lung diseases. Pressure on the limited donor pool has led to the use of extended criteria donors. One aspect of this has been the liberalization of the use of smoking donors (SmD).
  
  
  METHODS
  This study is a retrospective review of lung transplants performed between April 1995 and August 2008 at a single institute. We examined the impact of donor smoking on short-term and long-term survival in relationship to recipient and donor demographics such as ischemic time, cytomegalovirus status, rates of rejection and infection, ventilation, and intensive care stay. Endpoints were survival, infection, and rejection.
  
  
  RESULTS
  During this 13-year period, 454 lung transplants were performed. Smoking history was available on 424 (93.4%) of these (SmD, n = 184; NSmD, n = 240). Seventy-one patients died within 3 months of transplant leaving 353 alive at 3 months posttransplant. Fatalities within the first 3 months were significantly higher in the SmD group (21% vs 13%, odds ratio 1.9, hazard ratio 3.3, p = 0.04). No significant difference in rejection and infection rates between recipients of lungs from SmD and NSmD at 3 months and at 1 year posttransplantation (p = 0.51 and 0.09) was found. Although recipients of lungs from SmD had higher odds of ventilation for more than 10 hours, the odds were only increased by 20%, which was not statistically significant. Recipients from SmD had significantly longer stays in the intensive care (odds ratio 1.9, p = 0.002). There was little evidence for an effect of SmD on the development of bronchiolitis obliterans.
  
  
  CONCLUSIONS
  In this large cohort of patients, donor smoking history has an effect on early survival but no effect on long-term survival. The cause of this early mortality is independent of infection and rejection. However, these data suggest that overall outcomes from the use of donor lungs from smokers are acceptable, particularly in the current era with limited donor organs.
authors.affiliation: Cardiothoracic Transplant Unit, Papworth Hospital, Cambridge, United Kingdom.
authors.forename: Marius
authors.initials: M
authors.lastname: Berman
authors.forename: Kim
authors.initials: K
authors.lastname: Goldsmith
authors.forename: David
authors.initials: D
authors.lastname: Jenkins
authors.forename: Catherine
authors.initials: C
authors.lastname: Sudarshan
authors.forename: Pedro
authors.initials: P
authors.lastname: Catarino
authors.forename: Nair
authors.initials: N
authors.lastname: Sukumaran
authors.forename: John
authors.initials: J
authors.lastname: Dunning
authors.forename: Linda D
authors.initials: LD
authors.lastname: Sharples
authors.forename: Steven
authors.initials: S
authors.lastname: Tsui
authors.forename: Jasvir
authors.initials: J
authors.lastname: Parmar
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014019:Tissue Donors; D006113:United Kingdom / Q000453:epidemiology