V. A. Fleetwood2, J. Zimmermann2, J. Poirier2, M. Hertl1, E. Y. Chan1 1Rush University Medical Center,Department Of General Surgery, Division Of Transplantation Surgery,Chicago, IL, USA 2Rush University Medical Center,Department Of General Surgery,Chicago, IL, USA
Introduction:
Tobacco abuse is prevalent in the United States, with an estimated 18% of adults reporting smoking in 2012. The smoking epidemic has not spared those with end stage liver disease. In patients presenting for evaluation for liver transplantation (OLT), smoking rates were up to 75%, elevated especially in those with alcoholic liver disease. Only an estimated 20% of transplant centers have a tobacco use policy. Multiple studies have demonstrated higher morbidity and mortality in transplant patients who smoke, with an established higher risk of vascular and biliary graft complications, malignancy, and recidivism. Despite this literature, there remains a paucity of evidence on the incidence of wound complications after OLT in smokers. The aim of our study was to elucidate the association between tobacco abuse and both wound infections and hernias after OLT.
Methods:
We performed a retrospective single-center review of 141 patients having undergone OLT between January 1, 2004 and December 31st, 2013. We restricted our study to patients who received MELD exception points in order to capture a less systemically ill cohort pre-transplantation. Endpoints were wound infection and incisional hernia. Patients were defined as smokers (56/141, or 40%) or nonsmokers (85/141, or 60%) based on initial assessment. Analysis was performed using Fisher’s exact test, and odds ratios (OR) and confidence intervals (CI) were calculated with R statistical software.
Results:
Neither the incidence of incisional hernia nor of wound infection was significantly higher in smokers. The odds ratio for herniation in smokers was 0.71 (CI 0.23-2.20). Wound infections appeared to be similarly unrelated to smoking status (OR 1.49, CI 0.20-10.90). Our review involved a small sample size but remained adequate for detection of differences between smokers and nonsmokers at the rate of 2 hernias per 100 patients (1.95%) or more (with power =.08 and an alpha=.05).
Conclusion:
Our study revealed no significant difference in rates of wound infection or hernia development in patients smoking at the time of transplantation. According to the data presented, it is questionable whether there is sufficient evidence to deny liver transplantation on the basis of tobacco use. However, although we have established that smoking and the short-term complications of wound infection and hernia do not correlate, the long-term complications – including malignancy, lung disease, heart disease, and graft complications – are well described in the literature. We recommend each transplant center evaluate their policy on tobacco use.
