Background: The deleterious effects of cigarette smoking contribute to a number of significant health-related problems but the effect of donor smoking history on kidney graft outcomes is less clear.

Methods: We performed a retrospective single-institution review of 635 living kidney transplantations in an attempt to ascertain the effect of donor cigarette smoking and graft survival. Kaplan-Meier survival analysis and Cox-modeling were utilized. Donor and recipient characteristics were controlled in the final analyses.

Results: Twenty-six percent of donors smoked within 1 year prior to their donor nephrectomy. Donor smoking was significantly associated with reduced death-censored graft survival. Donors who smoked had graft survivals of 93%, 75% and 52% at 1, 5, and 10 years respectively and 96%, 85%, and 63% for donors who did not smoke (p<0.01). In Cox proportional hazard model, when compared to non-smokers, grafts harvested from donors who have smoked within one year of donor nephrectomy resulted in hazard-ratio for graft loss of 1.74 (p<0.01).

Conclusions: When controlled for donor and recipient factors, cigarette smoking by living kidney donors significantly reduced graft survival. This data 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.

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