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Effects of smoking on survival for patients with end-stage liver disease.

Abstract

BACKGROUND

Smokers with chronic liver disease can become eligible for transplantation, but some insurers refuse reimbursement pending smoking cessation.

STUDY DESIGN

Our hypothesis is that liver transplantation candidates and recipients who smoke have inferior survival compared with nonsmokers. Using a retrospective cohort study design, three Cox proportional hazards models were constructed to determine covariate-adjusted mortality from transplantation evaluation and transplantation based on smoking status at evaluation, transplantation, and posttransplantation followup.

RESULTS

From 1999 to 2007, 2,260 patients were evaluated. Seven hundred sixty were active smokers, and 1,500 were nonsmokers. Smokers at evaluation were younger (49.3 versus 51.7 years), were more likely to be men (65.9% versus 58.7%), have hepatitis C (54.2% versus 30.1%), have a lower Model for End-Stage Liver Disease score (10.5 versus 12.3), and less likely to receive transplant (12.2% versus 18.6%) (all p < 0.05). The postevaluation multivariate model indicated that substance use, higher Model for End-Stage Liver Disease score, hepatitis C, and older age increased mortality risk (all p < 0.05), and liver transplantation (hazards ratio = 0.986; 95% CI, 0.977 to 0.994) was associated with lower mortality. Smoking was not associated with increased mortality risk at any time point in those evaluated or receiving transplants.

CONCLUSIONS

Providers should continue encouraging potential liver transplantation candidates to stop smoking, but insurer-driven mandated smoking cessation might not improve survival.

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  • Authors+Show Affiliations

    ,

    Summer Student Research Program, Department of Surgery, University of Michigan, Ann Arbor, MI 48109-0331, USA.

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    Source

    MeSH

    Comorbidity
    Female
    Humans
    Liver Failure
    Liver Transplantation
    Male
    Middle Aged
    Proportional Hazards Models
    Retrospective Studies
    Smoking
    Survival Analysis

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    19476895

    Citation

    Lee, Dennis S., et al. "Effects of Smoking On Survival for Patients With End-stage Liver Disease." Journal of the American College of Surgeons, vol. 208, no. 6, 2009, pp. 1077-84.
    Lee DS, Mathur AK, Acker WB, et al. Effects of smoking on survival for patients with end-stage liver disease. J Am Coll Surg. 2009;208(6):1077-84.
    Lee, D. S., Mathur, A. K., Acker, W. B., Al-Holou, S. N., Ehrlichman, L. K., Lewin, S. A., ... Englesbe, M. J. (2009). Effects of smoking on survival for patients with end-stage liver disease. Journal of the American College of Surgeons, 208(6), pp. 1077-84. doi:10.1016/j.jamcollsurg.2009.01.050.
    Lee DS, et al. Effects of Smoking On Survival for Patients With End-stage Liver Disease. J Am Coll Surg. 2009;208(6):1077-84. PubMed PMID: 19476895.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effects of smoking on survival for patients with end-stage liver disease. AU - Lee,Dennis S, AU - Mathur,Amit K, AU - Acker,William B,2nd AU - Al-Holou,Shaza N, AU - Ehrlichman,Lauren K, AU - Lewin,Sarah A, AU - Nguyen,Christopher K B, AU - Peterson,Sarah F, AU - Ranney,David N, AU - Sell,Kristen, AU - Kubus,James, AU - Englesbe,Michael J, Y1 - 2009/04/24/ PY - 2008/11/17/received PY - 2009/01/13/revised PY - 2009/01/29/accepted PY - 2009/5/30/entrez PY - 2009/5/30/pubmed PY - 2009/6/10/medline SP - 1077 EP - 84 JF - Journal of the American College of Surgeons JO - J. Am. Coll. Surg. VL - 208 IS - 6 N2 - BACKGROUND: Smokers with chronic liver disease can become eligible for transplantation, but some insurers refuse reimbursement pending smoking cessation. STUDY DESIGN: Our hypothesis is that liver transplantation candidates and recipients who smoke have inferior survival compared with nonsmokers. Using a retrospective cohort study design, three Cox proportional hazards models were constructed to determine covariate-adjusted mortality from transplantation evaluation and transplantation based on smoking status at evaluation, transplantation, and posttransplantation followup. RESULTS: From 1999 to 2007, 2,260 patients were evaluated. Seven hundred sixty were active smokers, and 1,500 were nonsmokers. Smokers at evaluation were younger (49.3 versus 51.7 years), were more likely to be men (65.9% versus 58.7%), have hepatitis C (54.2% versus 30.1%), have a lower Model for End-Stage Liver Disease score (10.5 versus 12.3), and less likely to receive transplant (12.2% versus 18.6%) (all p < 0.05). The postevaluation multivariate model indicated that substance use, higher Model for End-Stage Liver Disease score, hepatitis C, and older age increased mortality risk (all p < 0.05), and liver transplantation (hazards ratio = 0.986; 95% CI, 0.977 to 0.994) was associated with lower mortality. Smoking was not associated with increased mortality risk at any time point in those evaluated or receiving transplants. CONCLUSIONS: Providers should continue encouraging potential liver transplantation candidates to stop smoking, but insurer-driven mandated smoking cessation might not improve survival. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/19476895/Effects_of_smoking_on_survival_for_patients_with_end_stage_liver_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(09)00222-1 DB - PRIME DP - Unbound Medicine ER -