Introduction

Tobacco use is associated with multiple medical problems including an increased risk of cancer (CA). The risk of CA is increased in the post-transplant period. This study is a retrospective chart review of a large number of liver transplant (LT) recipients to determine if a history of tobacco use is associated with incidence and type of post-transplant CA.

Methods

The records of 1315 consecutive liver transplant patients with a minimum of 6-months follow-up from 2001 to 2011 were reviewed (median 52 months). Patients were categorized as Current smoker, Previous smoker, or Never smoker (NS, n=684). Cox regression was utilized to evaluate long-term patient survival with covariates being MELD, recipient age, donor age and Hepatitis C diagnosis.

Results

Current (n=291) and previous smokers (n=340) were more likely to have hepatocellular CA at transplant (26%, 29%, versus 19% (NS), p=0.001), and these two groups had higher recurrence rates (21%, 14%, versus were 11% (NS), p=0.18). De-novo non-HCC CA was higher for current and previous smokers, compared to NS (18%, 16%, versus 12%, p=0.05). Among those with de-novo CA (n=180), the two smoking groups were more likely to have non-skin CA (59%, 50% versus 23%, p<0.001). Patient survival at 10-years was much worse for current smokers than the other study groups (54% vs 70%, p<0.01).

Conclusions

These results demonstrate an increased risk in tobacco users for pre-transplant HCC, a higher recurrence rate for post-transplant HCC, and a higher risk of post-transplant de-novo CA. Smokers were more likely to have de-novo non-skin CA, compared to NS. Post liver transplant long term survival is significantly decreased in smokers.

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