title: Correlates and Outcomes of Posttransplant Smoking in Solid Organ Transplant Recipients: A Systematic Literature Review and Meta-Analysis.
abstract: Despite smoking being an absolute or relative contraindication for transplantation, about 11% to 40% of all patients continue or resume smoking posttransplant. This systematic review with meta-analysis investigated the correlates and outcomes associated with smoking after solid organ transplantation.
  
  
  
  We searched PubMed, EMBASE, CINAHL, and PsycINFO from inception until January 2016, using state-of-the art methodology. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were computed for correlates/outcomes investigated 5 times or more.
  
  
  
  Seventy-three studies (43 in kidney, 17 in heart, 12 in liver, 1 in lung transplantation) investigated 95 correlates and 24 outcomes, of which 6 correlates and 4 outcomes could be included in the meta-analysis. The odds of smoking posttransplant were 1.33 times higher in men (95% CI, 1.12-1.57). Older individuals were significantly less likely to smoke (OR, 0.48; 95% CI, 0.38-0.62), as were patients with a higher body mass index (OR, 0.68; 95% CI, 0.52-0.89). Hypertension (OR, 1.16; 95% CI, 0.77-1.75), diabetes mellitus (OR, 0.52; 95% CI, 0.15-1.78), and having a history of cardiovascular disease (OR, 0.92; 95% CI, 0.77-1.09) were not significant correlates. Posttransplant smokers had higher odds of newly developed posttransplant cardiovascular disease (OR, 1.41; 95% CI, 1.02-1.95), nonskin malignancies (OR, 2.58; 95% CI, 1.26-5.29), a shorter patient survival time (OR, 0.59; 95% CI, 0.44-0.79), and higher odds of mortality (OR, 1.74; 95% CI, 1.21-2.48).
  
  
  
  Posttransplant smoking is associated with poor outcomes. Our results might help clinicians to understand which patients are more likely to smoke posttransplant, guide interventional approaches, and provide recommendations for future research.
authors.affiliation: 1 Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Belgium. 2 Heart Transplantation Program, University Hospitals of Leuven, Belgium. 3 Centre of Sleep Medicine, Hirslanden Group Zürich, Switzerland. 4 School of Nursing, University of Pittsburgh, Pittsburgh, PA. 5 Department of Anesthesiology, University Hospital of Basel, Switzerland. 6 Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA. 7 Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy. 8 Institute of Nursing Science, University of Basel, Switzerland.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Duerinckx
authors.forename: Hanna
authors.initials: H
authors.lastname: Burkhalter
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Engberg
authors.forename: Monika
authors.initials: M
authors.lastname: Kirsch
authors.forename: Mary-Lou
authors.initials: ML
authors.lastname: Klem
authors.forename: Susan M
authors.initials: SM
authors.lastname: Sereika
authors.forename: Paolo
authors.initials: P
authors.lastname: De Simone
authors.forename: Sabina
authors.initials: S
authors.lastname: De Geest
authors.forename: Fabienne
authors.initials: F
authors.lastname: Dobbels
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012907:Smoking / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult