title: Smoking is a risk factor for graft failure and mortality after renal transplantation.
abstract: BACKGROUND
  Smoking in renal transplant recipients (RTR) is an acknowledged cardiovascular risk factor. It is, however, unclear whether smoking also increases the risk of graft failure (GF).
  
  
  METHODS
  In this study, we prospectively assessed the association of current smoking versus past and never smoking with GF and mortality in 604 RTR (age 51.5 ± 12.1 years, 55% male).
  
  
  RESULTS
  At inclusion, 133 (22%) were current smokers, 255 (42%) were past smokers and 216 (36%) never smoked. During follow-up of 5.3 (4.7-5.7) years, 41 (7%) RTR experienced GF and 95 RTR (16%) died. Current smoking RTR had higher risk for GF compared to never smoking RTR (hazard ratio, HR = 3.3, 95% CI 1.5-7.1, p = 0.002). Past smoking RTR had similar risk of GF as never smoking RTR (HR = 1.1, 95% CI 0.5-2.6, p = 0.7). Current smoking RTR and past smoking RTR were at higher risk for death than never smoking RTR (HR = 2.1, 95% CI 1.1-3.8, p = 0.016, and HR = 2.4, 95% CI 1.4-4.0, p = 0.001, respectively).
  
  
  CONCLUSIONS
  Smoking after renal transplantation is associated with risk for GF and mortality. Since past smoking is a risk factor for mortality but not for GF, smoking cessation may be beneficial to RTR in delaying GF in long term.
authors.affiliation: Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Pramod K
authors.initials: PK
authors.lastname: Agarwal
authors.forename: Merel E
authors.initials: ME
authors.lastname: Hellemons
authors.forename: Dorien M
authors.initials: DM
authors.lastname: Zelle
authors.forename: Rutger M
authors.initials: RM
authors.lastname: van Ree
authors.forename: Jacob
authors.initials: J
authors.lastname: van den Born
authors.forename: Jaap J Homan
authors.initials: JJ
authors.lastname: van der Heide
authors.forename: Rijk O B
authors.initials: RO
authors.lastname: Gans
authors.forename: Willem J
authors.initials: WJ
authors.lastname: van Son
authors.forename: Gerjan
authors.initials: G
authors.lastname: Navis
authors.forename: Stephan J L
authors.initials: SJ
authors.lastname: Bakker
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation