title: Cigarette smoking in living kidney donors: donor and recipient outcomes.
abstract: BACKGROUND
  Living kidney donor pools are expanding with the use of "medically complex" donors. Whether or not to include cigarette smokers as living kidney donors remains unclear. The aim of this study was to determine the relationship between donor smoking and recipient outcomes. We hypothesized that donor smoking would increase donor complications and decrease allograft and recipient survival over time.
  
  
  METHODS
  The charts of 602 living kidney donors and their recipients were retrospectively reviewed. Kaplan-Meier survival analysis and Cox modeling were used to assess the relationships between smoking and recipient and allograft survival.
  
  
  RESULTS
  No difference in postoperative complications was seen in smoking versus non-smoking donors. Donor smoking at time of evaluation did not significantly decrease allograft survival (HR = 1.19, p = 0.52), but recipient smoking at evaluation did reduce allograft survival (HR = 1.74, p = 0.05). Both donor and recipient smoking decreased recipient survival (HR = 1.93, p < 0.01 vs HR = 1.74, p = 0.048).
  
  
  CONCLUSIONS
  When controlled for donor and recipient factors, cigarette smoking by living kidney donors significantly reduced recipient survival. This datum suggests that careful attention to smoking history is an important clinical measure in which to counsel potential donors and recipients. Policy efforts to limit donors with a recent smoking history should be balanced with the overall shortage of appropriate kidney donors.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Underwood
authors.forename: Kyle H
authors.initials: KH
authors.lastname: Sheetz
authors.forename: David C
authors.initials: DC
authors.lastname: Cron
authors.forename: Michael N
authors.initials: MN
authors.lastname: Terjimanian
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
authors.forename: Seth A
authors.initials: SA
authors.lastname: Waits
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000379:methods / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D014184:Transplantation, Homologous / Q000379:methods / Q000401:mortality; D055815:Young Adult
keywords: allograft; donor; nephrectomy; outcomes; recipient; smoking; survival