Introduction of routine monitoring of smoking resumption after lung transplantation

R.A.S. Hoek, L. den Ouden, L. Seghers, E. Mahtab, J.A. Bekkers, H.C. Hoogsteden, M.E. Hellemons

Thursday 15 march 2018

16:35 - 16:45h at Van de Vorm/Plate Zaal

Categories: Nursing, Session (parallel)

Parallel session: Parallel session 9: Nursing

Introduction

Active nicotine consumption is a contra-indication for lung transplantation (LuTx) in practically all centers worldwide. Resumption of smoking after lung transplantation can affect outcome in liver, heart, renal and lung transplantation and is associated with increase of oncologic events after solid organ transplantation. Active and second hand smoking can reliably tested with urine cotinine levels (UC). Because of negative outcome effect in LuTx, we introduced routine measurement of UC after LuTx to provide early intervention on smoking cessation and aimed to assess outcome in LuTx patients that resumed smoking.

Methods

We retrospectively assessed routine UC levels collected during outpatient visits in all patients transplanted between 2002 and 2016 and alive in 2016. We collected patient characteristics, smoking history (PY), UC levels and prevalence of obstructive chronic lung allograft dysfunction (oCLAD).

Results

Cotinine measurements were available for 123 of 130 patients at on average 4.6 years post-transplantation [range 0.4-14.8 years]. 3 patients had follow-up elsewhere, 2 patients died prior to measurement at outpatient visit in 2016, 2 patients were anuric. Of all screened patients 64% were former smokers, with a mean of 22±13 PY. The median cessation interval prior to transplantation was 9 years [IQR 4-15 years].

Of the 123 patients that underwent UC, 9 patients (7.3%) were found to have relapsed into active smoking (6 COPD, 2 IPF, 1 cystic fibrosis). Median UC value was 650 ng/mL [IQR 400-850]. Average number of PY in patients that relapsed was higher than in former smokers that did not relapse (32 vs. 20, P=0.02) and the smoking cessation interval in patients that relapsed was shorter (5 versus 12.5 years, P=0.05).

Remarkably; 1 and 5 year prevalence of oCLAD was significantly higher in patients that had relapsed smoking (17 versus 3% at 1 year and 17 versus 66% at 5 years respectively, P<0.004).

Conclusion

Routine monitoring of UC is an effective tool to detect smoking resumption after LuTx and offers opportunity for early intervention. When present, prevalence of oCLAD is high, although direct relationship cannot be established due to the late and cross-sectional screening for smoking.