TY - JOUR
T1 - Effects of Smoking on Survival for Patients with End-Stage Liver Disease
AU - Lee, Dennis S.
AU - Mathur, Amit K.
AU - Acker, William B.
AU - Al-Holou, Shaza N.
AU - Ehrlichman, Lauren K.
AU - Lewin, Sarah A.
AU - Nguyen, Christopher K.B.
AU - Peterson, Sarah F.
AU - Ranney, David N.
AU - Sell, Kristen
AU - Kubus, James
AU - Englesbe, Michael J.
N1 - Funding Information:
Dr Mathur is supported by a National Institutes of Health/National Research Service Award T32 institutional training grant. Dr Englesbe is supported by a grant from the American Surgical Association Foundation.
PY - 2009/6
Y1 - 2009/6
N2 - Background: Smokers with chronic liver disease can become eligible for transplantation, but some insurers refuse reimbursement pending smoking cessation. Study Design: Our hypothesis is that liver transplantation candidates and recipients who smoke have inferior survival compared with nonsmokers. Using a retrospective cohort study design, three Cox proportional hazards models were constructed to determine covariate-adjusted mortality from transplantation evaluation and transplantation based on smoking status at evaluation, transplantation, and posttransplantation followup. Results: From 1999 to 2007, 2,260 patients were evaluated. Seven hundred sixty were active smokers, and 1,500 were nonsmokers. Smokers at evaluation were younger (49.3 versus 51.7 years), were more likely to be men (65.9% versus 58.7%), have hepatitis C (54.2% versus 30.1%), have a lower Model for End-Stage Liver Disease score (10.5 versus 12.3), and less likely to receive transplant (12.2% versus 18.6%) (all p < 0.05). The postevaluation multivariate model indicated that substance use, higher Model for End-Stage Liver Disease score, hepatitis C, and older age increased mortality risk (all p < 0.05), and liver transplantation (hazards ratio = 0.986; 95% CI, 0.977 to 0.994) was associated with lower mortality. Smoking was not associated with increased mortality risk at any time point in those evaluated or receiving transplants. Conclusions: Providers should continue encouraging potential liver transplantation candidates to stop smoking, but insurer-driven mandated smoking cessation might not improve survival.
AB - Background: Smokers with chronic liver disease can become eligible for transplantation, but some insurers refuse reimbursement pending smoking cessation. Study Design: Our hypothesis is that liver transplantation candidates and recipients who smoke have inferior survival compared with nonsmokers. Using a retrospective cohort study design, three Cox proportional hazards models were constructed to determine covariate-adjusted mortality from transplantation evaluation and transplantation based on smoking status at evaluation, transplantation, and posttransplantation followup. Results: From 1999 to 2007, 2,260 patients were evaluated. Seven hundred sixty were active smokers, and 1,500 were nonsmokers. Smokers at evaluation were younger (49.3 versus 51.7 years), were more likely to be men (65.9% versus 58.7%), have hepatitis C (54.2% versus 30.1%), have a lower Model for End-Stage Liver Disease score (10.5 versus 12.3), and less likely to receive transplant (12.2% versus 18.6%) (all p < 0.05). The postevaluation multivariate model indicated that substance use, higher Model for End-Stage Liver Disease score, hepatitis C, and older age increased mortality risk (all p < 0.05), and liver transplantation (hazards ratio = 0.986; 95% CI, 0.977 to 0.994) was associated with lower mortality. Smoking was not associated with increased mortality risk at any time point in those evaluated or receiving transplants. Conclusions: Providers should continue encouraging potential liver transplantation candidates to stop smoking, but insurer-driven mandated smoking cessation might not improve survival.
UR - http://www.scopus.com/inward/record.url?scp=67349287365&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=67349287365&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2009.01.050
DO - 10.1016/j.jamcollsurg.2009.01.050
M3 - Article
C2 - 19476895
AN - SCOPUS:67349287365
SN - 1072-7515
VL - 208
SP - 1077
EP - 1084
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 6
ER -