Influence of donors’ cigarette smoking on recipients’ postoperative survival and complications after simultaneous pancreas-kidney transplantation

Abstract Background Many pancreatic transplant donors have smoking history. We aimed to evaluate the effect of donors’ smoking on recipient survival rates and postoperative complications. Methods Patients(N=6564) from the Scientific Registry of Transplant Recipients database who underwent simultaneous pancreas-kidney transplants (SPK) were divided into a cigarette group (n=5465) and non-cigarette group (n=799) based on their donors’ smoking history. Patients’ rates of overall and graft survival were compared and analyzed using the log-rank test. Hazard ratios were estimated using Cox proportional hazards models, and postoperative complications and dialysis times were evaluated using logistics analysis. Results The overall survival and graft survival of the patients in the non-cigarette group were significantly higher compared to those in the cigarette group ( P <0.05 for both log-rank tests). Cigarette smoking among the donors was associated with a significant difference in the recipients’ rate of pancreas graft survival and kidney graft survival ( P <0.05 for both log rank-tests). However, multivariate analyses indicated that donors’ smoking history was not an independent factor, while the donors’ age was associated with reduced survival (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.93-1.28; P =0.287). The cigarette group had a higher postoperative infection rate than the non-cigarette group (HR, 1.45; 95% CI, 1.02-2.06; P =0.038). Conclusions Donors’ smoking history has no overall effect on rates of overall or graft survival of SPK transplant recipients. However, it should be evaluated before transplantation because of its higher rate of postoperative complications.