Introduction: Current evidence from single-centre analyses suggest cigarette smoking in living donors is associated with worse patient but not graft survival in kidney allograft recipients. The effect of donor smoking status on recipient outcomes has not been clearly documented in a UK population. The aim of this nationwide analysis was to explore whether a kidney from a donor with a history of smoking had any impact upon hard recipient outcomes like mortality or allograft loss.

Methods: This study analysed the NHS Blood and Transplant dataset for all kidney transplants performed in the UK from April 2001 to April 2013. The effects on transplant outcome (graft and recipient survival) were examined with respect to the donors smoking history. Kaplan-Meier survival analysis and Cox proportional hazard modelling was used with covariates including donor variables, recipient variables and transplant variables included in the model.

Results: We analysed data on 21,805 kidney allograft recipients, with average follow up of 5.37 years. The cohort comprised on the following; first kidney transplant (n=18,922, 86.8%), incompatible kidney allograft (n=933, 4.3%), deceased donors (14,042, 64.4%), male (11,021, 50.5%) and Caucasian ethnicity (20,132, 92.4%). From the cohort, 7068 (32.4%) of the donors had a documented history of smoking. Donors after brain death or cardiac death were more likely to have smoking history compared to living donors (47.1% versus 43.7% versus 31.5% respectively, p<0.001). Donors who were smokers were more likely to be younger than the median age of 48, male and Caucasian. Our main finding was that donor history of smoking versus non-smoking significantly decreased patient survival (88.3% versus 89.8% respectively, p=0.003) but did not affect graft survival (84.1% versus 84.5% respectively, p=0.252). [figure 1]

Conclusion: Donor smoking is associated with decreased recipient survival but is not associated with adverse kidney allograft survival. This data corroborates some single-centre analyses and required further investigation, with data linkage across registries to minimise risk of confounding from unappreciated variables.

CITATION INFORMATION: Gillott H, Jackson-Spence F, Tahir S, Evison F, Nath J, Sharif A. Donor Smoking Increases Kidney Allograft Recipient Mortality in a National Population Cohort Analysis. Am J Transplant. 2016;16 (suppl 3).

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