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Transplantation141ReviewIranian Jou
Transplantation
141
Review
Iranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011
Impact of Cigarette Smoking on Kidney Transplant Recipients
A Systematic Review
Mohammad Hossein Nourbala, Eghlim Nemati, Zohreh Rostami,
Behzad Einollahi
Introduction. Cigarette smoking has adverse effects on kidney
transplant recipients, causing cardiovascular disease, kidney
function impairment, and cancer. However, there are surprisingly
few studies on the impact of cigarette smoking among kidney
transplant recipients and its consequences after transplantation.
We performed a systematic review of the literature to identify the
effects of cigarette smoking on patient and graft survival rates
among kidney transplant recipients.
Materials and Methods. We searched the PubMed from 1968
to 2009 to identify studies on the effect of cigarette smoking
on kidney transplant recipients, using the following keywords:
kidney transplantation, cigarette, smoking, tobacco, and nicotine. The
electronic and manual searches yielded 357 articles, of which 39
were considered potentially relevant by titles and abstracts and
were selected for full text review. Twenty-seven irrelevant reports
were excluded.
Results. A total of 12 papers were selected for review, comprising
of 1801 kidney transplant recipients with a history of smoking. The
impact of cigarette smoking on kidney recipient survival was only
evaluated by 6 studies and the relative risk of smoking for death
was available in 3 reports, varying between 0.8 and 2.2. Cigarette
smoking was an independent risk factor for patient death. In
addition, on univariable and multivariable analyses, graft survival
correlated with a history of cigarette smoking and the relative risk
for graft failure ranged from 1.06 to 2.3.
Conclusions. Cigarette smoking was associated with an increased
risk of death and graft loss. Therefore, every attempt should be
made to encourage kidney transplant candidates to stop smoking.
IJKD 2011;5:141-8
www.ijkd.org
Nephrology and Urology
Research Center, Baqiyatallah
University of Medical Sciences,
Tehran, Iran
Keywords. Cigarette, smoking,
renal transplantation, graft
survival, mortality
INTRODUCTION
Cardiovascular disease (CVD) is the leading cause
of mortality among kidney transplant recipients.1,2 In
addition, smoking is a major potentially modifiable
or avoidable risk factor for CVD.3,4 Ponticelli and
colleagues5 reported that smoking was associated
with a higher risk of CVD (relative risk [RR], 1.3;
P = .02) in 864 adults kidney transplant recipients.
Furthermore, Kasiske and coworkers6,7 found that
kidney transplant smokers had a greater risk of
ischemic heart disease (RR, 1.95) compared with
nonsmoking recipients. Recipient smokers have
a significantly shorter mean survival due to
mortality from CVD, in which smoking played
an important contributing role.8,9 In addition,
established cardiovascular risk factors other than
smoking, such as hypertension, diabetes mellitus,
and dyslipidemia, are more frequent in kidney
Smoking and Kidney Transplantation—Nourbala et al
142 Iranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011
transplant recipients than in the general population.
These risk factors increase the risk of CVD among
kidney transplant recipients and decrease patient
and graft survivals.10
Cancer, the second cause of death in kidney
transplant recipients, is another consequence
of smoking.11 Risk factors for malignancy after
transplantation include factors common to the
general population, such as age, smoking habits,
and sun exposure.12 For example, a series of 1500
kidney transplant recipients showed that age
greater than 45 years old (P = .007) and cigarette
smoking (P = .02) were significantly associated with
an elevated risk of malignancy.13 In a series of 84
heart transplants, cigarette smoking was associated
with reduced recipient survival and increased
risk of posttransplant cancer.14 Finally, cigarette
smoking is also a known major risk factor for the
development of chronic obstructive lung disease,
with 90% of mortality from chronic obstructive
lung disease directly attributable to smoking.15
Therefore, smoking can lead to reduced patient
survival by causing lung disease.
The prevalence of smoking among kidney
transplant recipients is 25% and 35% to 40% in
American and European patients, respectively.16,17
On the other hand, cigarette smoking is the world’s
major cause of premature mortality responsible for
an estimated 5 million deaths each year.18 Although
the adverse effects of smoking in the nontransplant
setting are well known, its impact on patient
and graft survival after kidney transplantation
remains unclear. There are, however, surprisingly
few studies addressing cigarette smoking among
kidney transplant recipients. Thus, we performed
a systematic review of the literature to identify the
effects of cigarette smoking on patient and graft
survival rates among kidney transplant recipients.
MATERIALS AND METHODS
We searched the PubMed database from 1968 to
2009 to identify studies that had reported the effect
of cigarette smoking on kidney transplant recipients.
Our keywords included kidney transplantation,
cigarette, smoking, tobacco, and nicotine and their
synonyms. To identify additional relevant articles,
bibliographies of qualitative topic reviews and the
identified articles were also searched. Duplicated
publications were discarded. We restricted our
search to human studies and placed no restrictions
on language. Our review aimed to address two
specific questions: (1) What is the effect of cigarette
smoking on kidney allograft survival? (2) What
is the effect of cigarette smoking on the kidney
transplant recipient survival?
There were not enough case-control and cohort
studies reporting adjusted RRs and 95% confidence
intervals (95% CI) of all-cause mortality and graft
failure among kidney transplant smokers relative
to nonsmoker patients (Table 1); therefore, we
could not assess the pooled adjusted RR and 95%
CI of these endpoints in a meta-analysis. Table 1
shows the characteristics of studies included in
this review.1,4,8,9,16,17,19-24
RESULTS
The electronic and manual searches yielded 357
papers by titles and abstracts, of which 39 were
Number of Patients
Authors Year Country Study Design All Smokers
Arend et al1 1997 Netherlands Retrospective cohort 804 394
Cosio et al8 1999 US Retrospective cohort 523 147
Kasiske and Klinger17 2000 US Retrospective cohort 1334 330
Matas et al21 2001 US Retrospective cohort 2540 …*
Sung et al19 2001 US Retrospective cohort 645 156
Woo et al9 2002 UK Retrospective cohort 515 234
Yavuz et al16 2004 Turkey Retrospective cohort 226 97
Kheradmand and Shahbazian20 2005 Iran Retrospective cohort 199 41
Zitt et al23 2007 Austria Prospective cohort 76 76
Suneja et al24 2007 US Case report 1 1
Banas et al4 2008 Germany Cross-sectional 264 156
Mohamed et al22 2009 India Retrospective cohort 303 169
Table 1. Baseline Characteristics of Studies Included in This Review
*Number of patients with a history of smoking was not provided in the article.
Smoking and Kidney Transplantation—Nourbala et al
Iranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011 143
considered potentially relevant and were selected
for full text review. Twenty-seven irrelevant
reports were excluded. After full text review, 9
retrospective cohort studies, 1 prospective cohort
study, 1 cross-sectional study, and 1 case report
were selected for our review (Table 1). Eighteen
hundred and one patients with a history of smoking
before kidney transplantation (ex-smoker) or after
kidney transplantation were included in this review.
The impact of cigarette smoking on kidney
recipient survival had been evaluated by 6
studies,1,8,9,16,17,19 and the RR of smoking for death
was available in 3 reports, varying from 0.8 to
2.2.1,9,17 Cigarette smoking was an independent risk
factor for patient survival, and kidney transplant
recipients with a smoking history had a significantly
shorter survival (Table 2). However, Yavuz
and colleagues, who only reported univariable
analysis, did not find a decreased patient survival
in smokers after transplantation.16 Univariable19,20
and multivariable8,9,17,19,21 analyses showed that
graft survival correlated with a history of cigarette
smoking, and the RR for graft failure ranged from
1.06 to 2.3 (Table 2). In contrast, two retrospective
cohort studies showed that cigarette smoking was
not a risk factor for graft failure on univariable
analysis.16,22 However, it should be noted that the
number of patients included in these studies was
relatively small (Table 1).
Kasiske and Klinger reported the prevalence of
cigarette smoking and its impact on patient and
graft survival in a large cohort of kidney transplant
recipients.17 The total number of pack-years smoked
reported at the time of kidney transplantation was
a stronger predictor for transplant outcomes. In
univariable analysis, smoking more than 25 packyears
at the time of kidney transplantation was
associated with increased graft loss and a higher
mortality rate (Table 2). After adjusting for multiple
predictors of kidney allograft loss, smoking more
than 25 pack-years (compared to smoking less than
25 pack-years or no smoking) was associated with a
30% higher risk of graft loss (Table 1). Having quit
smoking more than 5 year prior transplantation
reduced the relative risk of kidney allograft loss
by 34% (Table 2). This increased graft loss was
largely due to the increased mortality.17 The total
consumption of cigarette smoking was associated
with CVD; for example, the RR of smoking 11 to
25 pack-years at the time of transplantation was
1.56 (95% CI, 1.06 to 2.31; P = .02), whereas that of
smoking more than 25 pack-years was 2.14 (
141
Review
Iranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011
Impact of Cigarette Smoking on Kidney Transplant Recipients
A Systematic Review
Mohammad Hossein Nourbala, Eghlim Nemati, Zohreh Rostami,
Behzad Einollahi
Introduction. Cigarette smoking has adverse effects on kidney
transplant recipients, causing cardiovascular disease, kidney
function impairment, and cancer. However, there are surprisingly
few studies on the impact of cigarette smoking among kidney
transplant recipients and its consequences after transplantation.
We performed a systematic review of the literature to identify the
effects of cigarette smoking on patient and graft survival rates
among kidney transplant recipients.
Materials and Methods. We searched the PubMed from 1968
to 2009 to identify studies on the effect of cigarette smoking
on kidney transplant recipients, using the following keywords:
kidney transplantation, cigarette, smoking, tobacco, and nicotine. The
electronic and manual searches yielded 357 articles, of which 39
were considered potentially relevant by titles and abstracts and
were selected for full text review. Twenty-seven irrelevant reports
were excluded.
Results. A total of 12 papers were selected for review, comprising
of 1801 kidney transplant recipients with a history of smoking. The
impact of cigarette smoking on kidney recipient survival was only
evaluated by 6 studies and the relative risk of smoking for death
was available in 3 reports, varying between 0.8 and 2.2. Cigarette
smoking was an independent risk factor for patient death. In
addition, on univariable and multivariable analyses, graft survival
correlated with a history of cigarette smoking and the relative risk
for graft failure ranged from 1.06 to 2.3.
Conclusions. Cigarette smoking was associated with an increased
risk of death and graft loss. Therefore, every attempt should be
made to encourage kidney transplant candidates to stop smoking.
IJKD 2011;5:141-8
www.ijkd.org
Nephrology and Urology
Research Center, Baqiyatallah
University of Medical Sciences,
Tehran, Iran
Keywords. Cigarette, smoking,
renal transplantation, graft
survival, mortality
INTRODUCTION
Cardiovascular disease (CVD) is the leading cause
of mortality among kidney transplant recipients.1,2 In
addition, smoking is a major potentially modifiable
or avoidable risk factor for CVD.3,4 Ponticelli and
colleagues5 reported that smoking was associated
with a higher risk of CVD (relative risk [RR], 1.3;
P = .02) in 864 adults kidney transplant recipients.
Furthermore, Kasiske and coworkers6,7 found that
kidney transplant smokers had a greater risk of
ischemic heart disease (RR, 1.95) compared with
nonsmoking recipients. Recipient smokers have
a significantly shorter mean survival due to
mortality from CVD, in which smoking played
an important contributing role.8,9 In addition,
established cardiovascular risk factors other than
smoking, such as hypertension, diabetes mellitus,
and dyslipidemia, are more frequent in kidney
Smoking and Kidney Transplantation—Nourbala et al
142 Iranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011
transplant recipients than in the general population.
These risk factors increase the risk of CVD among
kidney transplant recipients and decrease patient
and graft survivals.10
Cancer, the second cause of death in kidney
transplant recipients, is another consequence
of smoking.11 Risk factors for malignancy after
transplantation include factors common to the
general population, such as age, smoking habits,
and sun exposure.12 For example, a series of 1500
kidney transplant recipients showed that age
greater than 45 years old (P = .007) and cigarette
smoking (P = .02) were significantly associated with
an elevated risk of malignancy.13 In a series of 84
heart transplants, cigarette smoking was associated
with reduced recipient survival and increased
risk of posttransplant cancer.14 Finally, cigarette
smoking is also a known major risk factor for the
development of chronic obstructive lung disease,
with 90% of mortality from chronic obstructive
lung disease directly attributable to smoking.15
Therefore, smoking can lead to reduced patient
survival by causing lung disease.
The prevalence of smoking among kidney
transplant recipients is 25% and 35% to 40% in
American and European patients, respectively.16,17
On the other hand, cigarette smoking is the world’s
major cause of premature mortality responsible for
an estimated 5 million deaths each year.18 Although
the adverse effects of smoking in the nontransplant
setting are well known, its impact on patient
and graft survival after kidney transplantation
remains unclear. There are, however, surprisingly
few studies addressing cigarette smoking among
kidney transplant recipients. Thus, we performed
a systematic review of the literature to identify the
effects of cigarette smoking on patient and graft
survival rates among kidney transplant recipients.
MATERIALS AND METHODS
We searched the PubMed database from 1968 to
2009 to identify studies that had reported the effect
of cigarette smoking on kidney transplant recipients.
Our keywords included kidney transplantation,
cigarette, smoking, tobacco, and nicotine and their
synonyms. To identify additional relevant articles,
bibliographies of qualitative topic reviews and the
identified articles were also searched. Duplicated
publications were discarded. We restricted our
search to human studies and placed no restrictions
on language. Our review aimed to address two
specific questions: (1) What is the effect of cigarette
smoking on kidney allograft survival? (2) What
is the effect of cigarette smoking on the kidney
transplant recipient survival?
There were not enough case-control and cohort
studies reporting adjusted RRs and 95% confidence
intervals (95% CI) of all-cause mortality and graft
failure among kidney transplant smokers relative
to nonsmoker patients (Table 1); therefore, we
could not assess the pooled adjusted RR and 95%
CI of these endpoints in a meta-analysis. Table 1
shows the characteristics of studies included in
this review.1,4,8,9,16,17,19-24
RESULTS
The electronic and manual searches yielded 357
papers by titles and abstracts, of which 39 were
Number of Patients
Authors Year Country Study Design All Smokers
Arend et al1 1997 Netherlands Retrospective cohort 804 394
Cosio et al8 1999 US Retrospective cohort 523 147
Kasiske and Klinger17 2000 US Retrospective cohort 1334 330
Matas et al21 2001 US Retrospective cohort 2540 …*
Sung et al19 2001 US Retrospective cohort 645 156
Woo et al9 2002 UK Retrospective cohort 515 234
Yavuz et al16 2004 Turkey Retrospective cohort 226 97
Kheradmand and Shahbazian20 2005 Iran Retrospective cohort 199 41
Zitt et al23 2007 Austria Prospective cohort 76 76
Suneja et al24 2007 US Case report 1 1
Banas et al4 2008 Germany Cross-sectional 264 156
Mohamed et al22 2009 India Retrospective cohort 303 169
Table 1. Baseline Characteristics of Studies Included in This Review
*Number of patients with a history of smoking was not provided in the article.
Smoking and Kidney Transplantation—Nourbala et al
Iranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011 143
considered potentially relevant and were selected
for full text review. Twenty-seven irrelevant
reports were excluded. After full text review, 9
retrospective cohort studies, 1 prospective cohort
study, 1 cross-sectional study, and 1 case report
were selected for our review (Table 1). Eighteen
hundred and one patients with a history of smoking
before kidney transplantation (ex-smoker) or after
kidney transplantation were included in this review.
The impact of cigarette smoking on kidney
recipient survival had been evaluated by 6
studies,1,8,9,16,17,19 and the RR of smoking for death
was available in 3 reports, varying from 0.8 to
2.2.1,9,17 Cigarette smoking was an independent risk
factor for patient survival, and kidney transplant
recipients with a smoking history had a significantly
shorter survival (Table 2). However, Yavuz
and colleagues, who only reported univariable
analysis, did not find a decreased patient survival
in smokers after transplantation.16 Univariable19,20
and multivariable8,9,17,19,21 analyses showed that
graft survival correlated with a history of cigarette
smoking, and the RR for graft failure ranged from
1.06 to 2.3 (Table 2). In contrast, two retrospective
cohort studies showed that cigarette smoking was
not a risk factor for graft failure on univariable
analysis.16,22 However, it should be noted that the
number of patients included in these studies was
relatively small (Table 1).
Kasiske and Klinger reported the prevalence of
cigarette smoking and its impact on patient and
graft survival in a large cohort of kidney transplant
recipients.17 The total number of pack-years smoked
reported at the time of kidney transplantation was
a stronger predictor for transplant outcomes. In
univariable analysis, smoking more than 25 packyears
at the time of kidney transplantation was
associated with increased graft loss and a higher
mortality rate (Table 2). After adjusting for multiple
predictors of kidney allograft loss, smoking more
than 25 pack-years (compared to smoking less than
25 pack-years or no smoking) was associated with a
30% higher risk of graft loss (Table 1). Having quit
smoking more than 5 year prior transplantation
reduced the relative risk of kidney allograft loss
by 34% (Table 2). This increased graft loss was
largely due to the increased mortality.17 The total
consumption of cigarette smoking was associated
with CVD; for example, the RR of smoking 11 to
25 pack-years at the time of transplantation was
1.56 (95% CI, 1.06 to 2.31; P = .02), whereas that of
smoking more than 25 pack-years was 2.14 (
0/5000
Transplantation141ReviewIranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011Impact of Cigarette Smoking on Kidney Transplant RecipientsA Systematic ReviewMohammad Hossein Nourbala, Eghlim Nemati, Zohreh Rostami,Behzad EinollahiIntroduction. Cigarette smoking has adverse effects on kidneytransplant recipients, causing cardiovascular disease, kidneyfunction impairment, and cancer. However, there are surprisinglyfew studies on the impact of cigarette smoking among kidneytransplant recipients and its consequences after transplantation.We performed a systematic review of the literature to identify theeffects of cigarette smoking on patient and graft survival ratesamong kidney transplant recipients.Materials and Methods. We searched the PubMed from 1968to 2009 to identify studies on the effect of cigarette smokingon kidney transplant recipients, using the following keywords:kidney transplantation, cigarette, smoking, tobacco, and nicotine. Theelectronic and manual searches yielded 357 articles, of which 39were considered potentially relevant by titles and abstracts andwere selected for full text review. Twenty-seven irrelevant reportswere excluded.Results. A total of 12 papers were selected for review, comprisingof 1801 kidney transplant recipients with a history of smoking. Theimpact of cigarette smoking on kidney recipient survival was onlyevaluated by 6 studies and the relative risk of smoking for deathwas available in 3 reports, varying between 0.8 and 2.2. Cigarettesmoking was an independent risk factor for patient death. Inaddition, on univariable and multivariable analyses, graft survivalcorrelated with a history of cigarette smoking and the relative riskfor graft failure ranged from 1.06 to 2.3.Conclusions. Cigarette smoking was associated with an increasedrisk of death and graft loss. Therefore, every attempt should bemade to encourage kidney transplant candidates to stop smoking.IJKD 2011;5:141-8www.ijkd.orgNephrology and UrologyResearch Center, BaqiyatallahUniversity of Medical Sciences,Tehran, IranKeywords. Cigarette, smoking,renal transplantation, graftsurvival, mortalityINTRODUCTIONCardiovascular disease (CVD) is the leading causeof mortality among kidney transplant recipients.1,2 Inaddition, smoking is a major potentially modifiableor avoidable risk factor for CVD.3,4 Ponticelli andcolleagues5 reported that smoking was associatedwith a higher risk of CVD (relative risk [RR], 1.3;P = .02) in 864 adults kidney transplant recipients.Furthermore, Kasiske and coworkers6,7 found thatkidney transplant smokers had a greater risk ofischemic heart disease (RR, 1.95) compared withnonsmoking recipients. Recipient smokers havea significantly shorter mean survival due tomortality from CVD, in which smoking playedan important contributing role.8,9 In addition,established cardiovascular risk factors other thansmoking, such as hypertension, diabetes mellitus,and dyslipidemia, are more frequent in kidneySmoking and Kidney Transplantation—Nourbala et al142 Iranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011transplant recipients than in the general population.These risk factors increase the risk of CVD amongkidney transplant recipients and decrease patientand graft survivals.10Cancer, the second cause of death in kidneytransplant recipients, is another consequenceof smoking.11 Risk factors for malignancy aftertransplantation include factors common to thegeneral population, such as age, smoking habits,and sun exposure.12 For example, a series of 1500kidney transplant recipients showed that agegreater than 45 years old (P = .007) and cigarettesmoking (P = .02) were significantly associated withan elevated risk of malignancy.13 In a series of 84heart transplants, cigarette smoking was associatedwith reduced recipient survival and increasedrisk of posttransplant cancer.14 Finally, cigarettesmoking is also a known major risk factor for thedevelopment of chronic obstructive lung disease,with 90% of mortality from chronic obstructivelung disease directly attributable to smoking.15Therefore, smoking can lead to reduced patientsurvival by causing lung disease.The prevalence of smoking among kidneytransplant recipients is 25% and 35% to 40% inAmerican and European patients, respectively.16,17من ناحية أخرى، هو تدخين السجائر في العالمالسبب الرئيسي للوفيات المبكرة المسؤولةما يقدر 5 مليون حالة وفاة كل year.18 على الرغم من أنالآثار الضارة للتدخين في نونترانسبلانتإعداد معروفة جيدا، أثره على المريضوبقاء الفساد بعد زرع الكليلا يزال غير واضح. ومع ذلك، هناك من المستغربقلة الدراسات معالجة تدخين السجائر بينمستلمي زرع الكلي. وهكذا، أجرينامراجعة منهجية للأدبيات للتعرفآثار تدخين السجائر على المريض والابتزازمعدلات البقاء على قيد الحياة بين الكلي زرع المستلمين.مواد وأساليببحثنا في قاعدة بيانات PubMed من عام 1968 إلى2009 لتحديد الدراسات التي أبلغت عن تأثيرلتدخين السجائر على الكلي وزراعة المستلمين.لدينا كلمات شملت زرع الكلي،السجائر والتدخين والتبغ والنيكوتين وبهمالمرادفات. لتحديد المواد ذات الصلة إضافية،مراجع ملاحظات الموضوع النوعيتم البحث أيضا في المواد التي تم تحديدها. تكرارمنشورات تم إهمالها. نحن مقيدة لديناالبحث على الإنسان دراسات ووضع أية قيودفي اللغة. هدف استعراضنا لمعالجة اثنينأسئلة محددة: (1) ما هو تأثير السجائرالتدخين على بقاء allograft الكلي؟ (2) ما هوهو تأثير السجائر التدخين في الكليزرع بقاء المستفيدة؟لم يكن هناك ما يكفي لمراقبة الحالة والاترابالدراسات الإبلاغ ضبط الثقة الاختطارات النسبية و 95 في المائةفواصل (95% CI) جميع أسباب الوفيات والابتزازفشل بين المدخنين زرع الكلي نسبينونسموكير المرضى (الجدول 1)؛ ولذلك، نحنلا يمكن تقدير الاختطار النسبي المعدل التجميعي و 95%كاريتاس الدولية لهذه النهاية في تحليل تلوي. الجدول 1ويبين خصائص الدراسات المدرجة فيهذا review.1,4,8,9,16,17,19-24النتائجأسفرت عمليات البحث الإلكترونية ودليل عن 357ورقات بالعناوين والملخصات، التي كانت 39عدد المرضىالكتاب السنة البلد دراسة تصميم جميع المدخنينارند et al1 الأتراب "الاستعادية هولندا" 1997 804 394كوسيو et al8 عام 1999 "أثر رجعي لنا" فوج 523 147فوج Kasiske والولايات المتحدة عام 2000 Klinger17 بأثر رجعي 1334 330ماتاس et al21 2001 "أثر رجعي لنا" الفوج 2540... *سونغ et al19 2001 "أثر رجعي لنا" فوج 645 156وو et al9 2002 الأتراب "الاستعادية المملكة المتحدة" 515 234يافوز et al16 2004 الأتراب "الاستعادية تركيا" 226 97الإمارة وإيران عام 2005 Shahbazian20 بأثر رجعي الفوج 199 41زيت et al23 2007 النمسا اترابيه 76 76سونيا et al24 2007 "الولايات المتحدة قضية" تقرير 1 1بأس et al4 2008 ألمانيا 264 156 مستعرضةMohamed et al22 الأتراب "الاستعادية الهند" 2009 303 169الجدول 1. خصائص خط الأساس للدراسات المشمولة في هذه المراجعة* عدد من المرضى مع تاريخ التدخين لم تقدم في هذه المادة.التدخين وزرع الكلي — نوربالا وآخرونالمجلة الإيرانية لأمراض الكلي | حجم 5 | رقم 3 | قد 2011 143يعتبر أنها يحتمل أن تكون ذات صلة، واختيرfor full text review. Twenty-seven irrelevantreports were excluded. After full text review, 9retrospective cohort studies, 1 prospective cohortstudy, 1 cross-sectional study, and 1 case reportwere selected for our review (Table 1). Eighteenhundred and one patients with a history of smokingbefore kidney transplantation (ex-smoker) or afterkidney transplantation were included in this review.The impact of cigarette smoking on kidneyrecipient survival had been evaluated by 6studies,1,8,9,16,17,19 and the RR of smoking for deathwas available in 3 reports, varying from 0.8 to2.2.1,9,17 Cigarette smoking was an independent riskfactor for patient survival, and kidney transplantrecipients with a smoking history had a significantlyshorter survival (Table 2). However, Yavuzand colleagues, who only reported univariableanalysis, did not find a decreased patient survivalin smokers after transplantation.16 Univariable19,20and multivariable8,9,17,19,21 analyses showed thatgraft survival correlated with a history of cigarettesmoking, and the RR for graft failure ranged from1.06 to 2.3 (Table 2). In contrast, two retrospectivecohort studies showed that cigarette smoking wasnot a risk factor for graft failure on univariableanalysis.16,22 However, it should be noted that thenumber of patients included in these studies wasrelatively small (Table 1).Kasiske and Klinger reported the prevalence ofcigarette smoking and its impact on patient andgraft survival in a large cohort of kidney transplantrecipients.17 The total number of pack-years smokedreported at the time of kidney transplantation wasa stronger predictor for transplant outcomes. Inunivariable analysis, smoking more than 25 packyearsat the time of kidney transplantation wasassociated with increased graft loss and a highermortality rate (Table 2). After adjusting for multiplepredictors of kidney allograft loss, smoking morethan 25 pack-years (compared to smoking less than25 pack-years or no smoking) was associated with a30% higher risk of graft loss (Table 1). Having quitsmoking more than 5 year prior transplantationreduced the relative risk of kidney allograft lossby 34% (Table 2). This increased graft loss waslargely due to the increased mortality.17 The totalconsumption of cigarette smoking was associatedwith CVD; for example, the RR of smoking 11 to25 pack-years at the time of transplantation was1.56 (95% CI, 1.06 to 2.31; P = .02), whereas that ofsmoking more than 25 pack-years was 2.14 (
يجري ترجمتها، يرجى الانتظار ..
زرع Transplantation
141 141
مراجعة Review
الإيراني مجلة أمراض الكلى | حجم 5 | عدد 3 | مايو 2011 Iranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011
أثر التدخين على الكلى متلقى Impact of Cigarette Smoking on Kidney Transplant Recipients
منهجية مراجعة A Systematic Review
محمد حسين Nourbala، Eghlim نعمتي، زهره رستمي، Mohammad Hossein Nourbala, Eghlim Nemati, Zohreh Rostami,
بهزاد Einollahi Behzad Einollahi
مقدمة. التدخين له آثار سلبية على الكلى Introduction. Cigarette smoking has adverse effects on kidney
متلقى، مما تسبب في أمراض القلب والشرايين والكلى transplant recipients, causing cardiovascular disease, kidney
وظيفة انخفاض القيمة، والسرطان. ومع ذلك، هناك من المستغرب function impairment, and cancer. However, there are surprisingly
قليل من الدراسات حول تأثير تدخين السجائر بين الكلى few studies on the impact of cigarette smoking among kidney
متلقى ونتائجه بعد الزرع. transplant recipients and its consequences after transplantation.
أجرينا مراجعة منهجية للأدب لتحديد We performed a systematic review of the literature to identify the
آثار التدخين على معدلات المريض وبقاء الكسب غير المشروع effects of cigarette smoking on patient and graft survival rates
بين المستفيدين زرع الكلى. among kidney transplant recipients.
المواد وطرق. بحثنا في مجلات عام 1968 من Materials and Methods. We searched the PubMed from 1968
لعام 2009 لتحديد الدراسات حول تأثير التدخين to 2009 to identify studies on the effect of cigarette smoking
على متلقي زرع الكلى، وذلك باستخدام الكلمات الأساسية التالية: on kidney transplant recipients, using the following keywords:
زرع الكلى، والسجائر، والتدخين، والتبغ، والنيكوتين. kidney transplantation, cigarette, smoking, tobacco, and nicotine. The
electronic and manual searches yielded 357 articles, of which 39
were considered potentially relevant by titles and abstracts and
were selected for full text review. Twenty-seven irrelevant reports
were excluded.
Results. A total of 12 papers were selected for review, comprising
of 1801 kidney transplant recipients with a history of smoking. The
impact of cigarette smoking on kidney recipient survival was only
evaluated by 6 studies and the relative risk of smoking for death
was available in 3 reports, varying between 0.8 and 2.2. Cigarette
smoking was an independent risk factor for patient death. In
addition, on univariable and multivariable analyses, graft survival
correlated with a history of cigarette smoking and the relative risk
for graft failure ranged from 1.06 to 2.3.
Conclusions. Cigarette smoking was associated with an increased
risk of death and graft loss. Therefore, every attempt should be
made to encourage kidney transplant candidates to stop smoking.
IJKD 2011;5:141-8
www.ijkd.org
Nephrology and Urology
Research Center, Baqiyatallah
University of Medical Sciences,
Tehran, Iran
Keywords. Cigarette, smoking,
renal transplantation, graft
survival, mortality
INTRODUCTION
Cardiovascular disease (CVD) is the leading cause
of mortality among kidney transplant recipients.1,2 In
addition, smoking is a major potentially modifiable
or avoidable risk factor for CVD.3,4 Ponticelli and
colleagues5 reported that smoking was associated
with a higher risk of CVD (relative risk [RR], 1.3;
P = .02) in 864 adults kidney transplant recipients.
Furthermore, Kasiske and coworkers6,7 found that
kidney transplant smokers had a greater risk of
ischemic heart disease (RR, 1.95) compared with
nonsmoking recipients. Recipient smokers have
a significantly shorter mean survival due to
mortality from CVD, in which smoking played
an important contributing role.8,9 In addition,
established cardiovascular risk factors other than
smoking, such as hypertension, diabetes mellitus,
and dyslipidemia, are more frequent in kidney
Smoking and Kidney Transplantation—Nourbala et al
142 Iranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011
transplant recipients than in the general population.
These risk factors increase the risk of CVD among
kidney transplant recipients and decrease patient
and graft survivals.10
Cancer, the second cause of death in kidney
transplant recipients, is another consequence
of smoking.11 Risk factors for malignancy after
transplantation include factors common to the
general population, such as age, smoking habits,
and sun exposure.12 For example, a series of 1500
kidney transplant recipients showed that age
greater than 45 years old (P = .007) and cigarette
smoking (P = .02) were significantly associated with
an elevated risk of malignancy.13 In a series of 84
heart transplants, cigarette smoking was associated
with reduced recipient survival and increased
risk of posttransplant cancer.14 Finally, cigarette
smoking is also a known major risk factor for the
development of chronic obstructive lung disease,
with 90% of mortality from chronic obstructive
lung disease directly attributable to smoking.15
Therefore, smoking can lead to reduced patient
survival by causing lung disease.
The prevalence of smoking among kidney
transplant recipients is 25% and 35% to 40% in
American and European patients, respectively.16,17
On the other hand, cigarette smoking is the world’s
major cause of premature mortality responsible for
an estimated 5 million deaths each year.18 Although
the adverse effects of smoking in the nontransplant
setting are well known, its impact on patient
and graft survival after kidney transplantation
remains unclear. There are, however, surprisingly
few studies addressing cigarette smoking among
kidney transplant recipients. Thus, we performed
a systematic review of the literature to identify the
effects of cigarette smoking on patient and graft
survival rates among kidney transplant recipients.
MATERIALS AND METHODS
We searched the PubMed database from 1968 to
2009 to identify studies that had reported the effect
of cigarette smoking on kidney transplant recipients.
Our keywords included kidney transplantation,
cigarette, smoking, tobacco, and nicotine and their
synonyms. To identify additional relevant articles,
bibliographies of qualitative topic reviews and the
identified articles were also searched. Duplicated
publications were discarded. We restricted our
search to human studies and placed no restrictions
on language. Our review aimed to address two
specific questions: (1) What is the effect of cigarette
smoking on kidney allograft survival? (2) What
is the effect of cigarette smoking on the kidney
transplant recipient survival?
There were not enough case-control and cohort
studies reporting adjusted RRs and 95% confidence
intervals (95% CI) of all-cause mortality and graft
failure among kidney transplant smokers relative
to nonsmoker patients (Table 1); therefore, we
could not assess the pooled adjusted RR and 95%
CI of these endpoints in a meta-analysis. Table 1
shows the characteristics of studies included in
this review.1,4,8,9,16,17,19-24
RESULTS
The electronic and manual searches yielded 357
papers by titles and abstracts, of which 39 were
Number of Patients
Authors Year Country Study Design All Smokers
Arend et al1 1997 Netherlands Retrospective cohort 804 394
Cosio et al8 1999 US Retrospective cohort 523 147
Kasiske and Klinger17 2000 US Retrospective cohort 1334 330
Matas et al21 2001 US Retrospective cohort 2540 …*
Sung et al19 2001 US Retrospective cohort 645 156
Woo et al9 2002 UK Retrospective cohort 515 234
Yavuz et al16 2004 Turkey Retrospective cohort 226 97
Kheradmand and Shahbazian20 2005 Iran Retrospective cohort 199 41
Zitt et al23 2007 Austria Prospective cohort 76 76
Suneja et al24 2007 US Case report 1 1
Banas et al4 2008 Germany Cross-sectional 264 156
Mohamed et al22 2009 India Retrospective cohort 303 169
Table 1. Baseline Characteristics of Studies Included in This Review
*Number of patients with a history of smoking was not provided in the article.
Smoking and Kidney Transplantation—Nourbala et al
Iranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011 143
considered potentially relevant and were selected
for full text review. Twenty-seven irrelevant
reports were excluded. After full text review, 9
retrospective cohort studies, 1 prospective cohort
study, 1 cross-sectional study, and 1 case report
were selected for our review (Table 1). Eighteen
hundred and one patients with a history of smoking
before kidney transplantation (ex-smoker) or after
kidney transplantation were included in this review.
The impact of cigarette smoking on kidney
recipient survival had been evaluated by 6
studies,1,8,9,16,17,19 and the RR of smoking for death
was available in 3 reports, varying from 0.8 to
2.2.1,9,17 Cigarette smoking was an independent risk
factor for patient survival, and kidney transplant
recipients with a smoking history had a significantly
shorter survival (Table 2). However, Yavuz
and colleagues, who only reported univariable
analysis, did not find a decreased patient survival
in smokers after transplantation.16 Univariable19,20
and multivariable8,9,17,19,21 analyses showed that
graft survival correlated with a history of cigarette
smoking, and the RR for graft failure ranged from
1.06 to 2.3 (Table 2). In contrast, two retrospective
cohort studies showed that cigarette smoking was
not a risk factor for graft failure on univariable
analysis.16,22 However, it should be noted that the
number of patients included in these studies was
relatively small (Table 1).
Kasiske and Klinger reported the prevalence of
cigarette smoking and its impact on patient and
graft survival in a large cohort of kidney transplant
recipients.17 The total number of pack-years smoked
reported at the time of kidney transplantation was
a stronger predictor for transplant outcomes. In
univariable analysis, smoking more than 25 packyears
at the time of kidney transplantation was
associated with increased graft loss and a higher
mortality rate (Table 2). After adjusting for multiple
predictors of kidney allograft loss, smoking more
than 25 pack-years (compared to smoking less than
25 pack-years or no smoking) was associated with a
30% higher risk of graft loss (Table 1). Having quit
smoking more than 5 year prior transplantation
reduced the relative risk of kidney allograft loss
by 34% (Table 2). This increased graft loss was
largely due to the increased mortality.17 The total
consumption of cigarette smoking was associated
with CVD; for example, the RR of smoking 11 to
25 pack-years at the time of transplantation was
1.56 (95% CI, 1.06 to 2.31; P = .02), whereas that of
smoking more than 25 pack-years was 2.14 (
141 141
مراجعة Review
الإيراني مجلة أمراض الكلى | حجم 5 | عدد 3 | مايو 2011 Iranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011
أثر التدخين على الكلى متلقى Impact of Cigarette Smoking on Kidney Transplant Recipients
منهجية مراجعة A Systematic Review
محمد حسين Nourbala، Eghlim نعمتي، زهره رستمي، Mohammad Hossein Nourbala, Eghlim Nemati, Zohreh Rostami,
بهزاد Einollahi Behzad Einollahi
مقدمة. التدخين له آثار سلبية على الكلى Introduction. Cigarette smoking has adverse effects on kidney
متلقى، مما تسبب في أمراض القلب والشرايين والكلى transplant recipients, causing cardiovascular disease, kidney
وظيفة انخفاض القيمة، والسرطان. ومع ذلك، هناك من المستغرب function impairment, and cancer. However, there are surprisingly
قليل من الدراسات حول تأثير تدخين السجائر بين الكلى few studies on the impact of cigarette smoking among kidney
متلقى ونتائجه بعد الزرع. transplant recipients and its consequences after transplantation.
أجرينا مراجعة منهجية للأدب لتحديد We performed a systematic review of the literature to identify the
آثار التدخين على معدلات المريض وبقاء الكسب غير المشروع effects of cigarette smoking on patient and graft survival rates
بين المستفيدين زرع الكلى. among kidney transplant recipients.
المواد وطرق. بحثنا في مجلات عام 1968 من Materials and Methods. We searched the PubMed from 1968
لعام 2009 لتحديد الدراسات حول تأثير التدخين to 2009 to identify studies on the effect of cigarette smoking
على متلقي زرع الكلى، وذلك باستخدام الكلمات الأساسية التالية: on kidney transplant recipients, using the following keywords:
زرع الكلى، والسجائر، والتدخين، والتبغ، والنيكوتين. kidney transplantation, cigarette, smoking, tobacco, and nicotine. The
electronic and manual searches yielded 357 articles, of which 39
were considered potentially relevant by titles and abstracts and
were selected for full text review. Twenty-seven irrelevant reports
were excluded.
Results. A total of 12 papers were selected for review, comprising
of 1801 kidney transplant recipients with a history of smoking. The
impact of cigarette smoking on kidney recipient survival was only
evaluated by 6 studies and the relative risk of smoking for death
was available in 3 reports, varying between 0.8 and 2.2. Cigarette
smoking was an independent risk factor for patient death. In
addition, on univariable and multivariable analyses, graft survival
correlated with a history of cigarette smoking and the relative risk
for graft failure ranged from 1.06 to 2.3.
Conclusions. Cigarette smoking was associated with an increased
risk of death and graft loss. Therefore, every attempt should be
made to encourage kidney transplant candidates to stop smoking.
IJKD 2011;5:141-8
www.ijkd.org
Nephrology and Urology
Research Center, Baqiyatallah
University of Medical Sciences,
Tehran, Iran
Keywords. Cigarette, smoking,
renal transplantation, graft
survival, mortality
INTRODUCTION
Cardiovascular disease (CVD) is the leading cause
of mortality among kidney transplant recipients.1,2 In
addition, smoking is a major potentially modifiable
or avoidable risk factor for CVD.3,4 Ponticelli and
colleagues5 reported that smoking was associated
with a higher risk of CVD (relative risk [RR], 1.3;
P = .02) in 864 adults kidney transplant recipients.
Furthermore, Kasiske and coworkers6,7 found that
kidney transplant smokers had a greater risk of
ischemic heart disease (RR, 1.95) compared with
nonsmoking recipients. Recipient smokers have
a significantly shorter mean survival due to
mortality from CVD, in which smoking played
an important contributing role.8,9 In addition,
established cardiovascular risk factors other than
smoking, such as hypertension, diabetes mellitus,
and dyslipidemia, are more frequent in kidney
Smoking and Kidney Transplantation—Nourbala et al
142 Iranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011
transplant recipients than in the general population.
These risk factors increase the risk of CVD among
kidney transplant recipients and decrease patient
and graft survivals.10
Cancer, the second cause of death in kidney
transplant recipients, is another consequence
of smoking.11 Risk factors for malignancy after
transplantation include factors common to the
general population, such as age, smoking habits,
and sun exposure.12 For example, a series of 1500
kidney transplant recipients showed that age
greater than 45 years old (P = .007) and cigarette
smoking (P = .02) were significantly associated with
an elevated risk of malignancy.13 In a series of 84
heart transplants, cigarette smoking was associated
with reduced recipient survival and increased
risk of posttransplant cancer.14 Finally, cigarette
smoking is also a known major risk factor for the
development of chronic obstructive lung disease,
with 90% of mortality from chronic obstructive
lung disease directly attributable to smoking.15
Therefore, smoking can lead to reduced patient
survival by causing lung disease.
The prevalence of smoking among kidney
transplant recipients is 25% and 35% to 40% in
American and European patients, respectively.16,17
On the other hand, cigarette smoking is the world’s
major cause of premature mortality responsible for
an estimated 5 million deaths each year.18 Although
the adverse effects of smoking in the nontransplant
setting are well known, its impact on patient
and graft survival after kidney transplantation
remains unclear. There are, however, surprisingly
few studies addressing cigarette smoking among
kidney transplant recipients. Thus, we performed
a systematic review of the literature to identify the
effects of cigarette smoking on patient and graft
survival rates among kidney transplant recipients.
MATERIALS AND METHODS
We searched the PubMed database from 1968 to
2009 to identify studies that had reported the effect
of cigarette smoking on kidney transplant recipients.
Our keywords included kidney transplantation,
cigarette, smoking, tobacco, and nicotine and their
synonyms. To identify additional relevant articles,
bibliographies of qualitative topic reviews and the
identified articles were also searched. Duplicated
publications were discarded. We restricted our
search to human studies and placed no restrictions
on language. Our review aimed to address two
specific questions: (1) What is the effect of cigarette
smoking on kidney allograft survival? (2) What
is the effect of cigarette smoking on the kidney
transplant recipient survival?
There were not enough case-control and cohort
studies reporting adjusted RRs and 95% confidence
intervals (95% CI) of all-cause mortality and graft
failure among kidney transplant smokers relative
to nonsmoker patients (Table 1); therefore, we
could not assess the pooled adjusted RR and 95%
CI of these endpoints in a meta-analysis. Table 1
shows the characteristics of studies included in
this review.1,4,8,9,16,17,19-24
RESULTS
The electronic and manual searches yielded 357
papers by titles and abstracts, of which 39 were
Number of Patients
Authors Year Country Study Design All Smokers
Arend et al1 1997 Netherlands Retrospective cohort 804 394
Cosio et al8 1999 US Retrospective cohort 523 147
Kasiske and Klinger17 2000 US Retrospective cohort 1334 330
Matas et al21 2001 US Retrospective cohort 2540 …*
Sung et al19 2001 US Retrospective cohort 645 156
Woo et al9 2002 UK Retrospective cohort 515 234
Yavuz et al16 2004 Turkey Retrospective cohort 226 97
Kheradmand and Shahbazian20 2005 Iran Retrospective cohort 199 41
Zitt et al23 2007 Austria Prospective cohort 76 76
Suneja et al24 2007 US Case report 1 1
Banas et al4 2008 Germany Cross-sectional 264 156
Mohamed et al22 2009 India Retrospective cohort 303 169
Table 1. Baseline Characteristics of Studies Included in This Review
*Number of patients with a history of smoking was not provided in the article.
Smoking and Kidney Transplantation—Nourbala et al
Iranian Journal of Kidney Diseases | Volume 5 | Number 3 | May 2011 143
considered potentially relevant and were selected
for full text review. Twenty-seven irrelevant
reports were excluded. After full text review, 9
retrospective cohort studies, 1 prospective cohort
study, 1 cross-sectional study, and 1 case report
were selected for our review (Table 1). Eighteen
hundred and one patients with a history of smoking
before kidney transplantation (ex-smoker) or after
kidney transplantation were included in this review.
The impact of cigarette smoking on kidney
recipient survival had been evaluated by 6
studies,1,8,9,16,17,19 and the RR of smoking for death
was available in 3 reports, varying from 0.8 to
2.2.1,9,17 Cigarette smoking was an independent risk
factor for patient survival, and kidney transplant
recipients with a smoking history had a significantly
shorter survival (Table 2). However, Yavuz
and colleagues, who only reported univariable
analysis, did not find a decreased patient survival
in smokers after transplantation.16 Univariable19,20
and multivariable8,9,17,19,21 analyses showed that
graft survival correlated with a history of cigarette
smoking, and the RR for graft failure ranged from
1.06 to 2.3 (Table 2). In contrast, two retrospective
cohort studies showed that cigarette smoking was
not a risk factor for graft failure on univariable
analysis.16,22 However, it should be noted that the
number of patients included in these studies was
relatively small (Table 1).
Kasiske and Klinger reported the prevalence of
cigarette smoking and its impact on patient and
graft survival in a large cohort of kidney transplant
recipients.17 The total number of pack-years smoked
reported at the time of kidney transplantation was
a stronger predictor for transplant outcomes. In
univariable analysis, smoking more than 25 packyears
at the time of kidney transplantation was
associated with increased graft loss and a higher
mortality rate (Table 2). After adjusting for multiple
predictors of kidney allograft loss, smoking more
than 25 pack-years (compared to smoking less than
25 pack-years or no smoking) was associated with a
30% higher risk of graft loss (Table 1). Having quit
smoking more than 5 year prior transplantation
reduced the relative risk of kidney allograft loss
by 34% (Table 2). This increased graft loss was
largely due to the increased mortality.17 The total
consumption of cigarette smoking was associated
with CVD; for example, the RR of smoking 11 to
25 pack-years at the time of transplantation was
1.56 (95% CI, 1.06 to 2.31; P = .02), whereas that of
smoking more than 25 pack-years was 2.14 (
يجري ترجمتها، يرجى الانتظار ..
زرع
141
استعراض Iranian journal of أمراض الكلى | حجم 5 | | رقم 3 مايو 2011
تأثير تدخين السجائر على زرع الكلى المستفيدين
مراجعة منهجية محمد حسين nourbala إغليم نعمتی, زهره
بهزاد رستمي، einollahi
مقدمة.تدخين السجائر له آثار سلبية على الكلى
المتلقين زرع، مما تسبب في أمراض القلب والشرايين والكلى
وظيفة البصر،و السرطان.ومع ذلك، هناك عدد قليل من غرابة
دراسات عن آثار تدخين السجائر بين الكليتين
المتلقين زرع ونتائجه بعد زرع
نفذنا مراجعة منهجية الدراسات لتحديد
آثار التدخين على المريض و الطعم معدلات البقاء على قيد الحياة
المواد بين المتلقين زرع الكلى. و الأساليب.بحثنا في مجلات من 1968
في عام 2009، بغية تحديد دراسات على تأثير تدخين السجائر
على المتلقين زرع الكلى، وذلك باستخدام الكلمات التالية:
زراعة الكلى, السجائر, تدخين التبغ و النيكوتين.
ويميلون في البحث اليدوي الإلكتروني 357 مقالة، منها 39
تعتبر ذات الصلة المحتملة من خلال عناوين وملخصات و تم اختيار
كاملا مراجعة النص.سبعة وعشرون أهمية التقارير
استبعدت نتائج
.ما مجموعه 12 ورقة تم اختيارها لإجراء الاستعراض، التي تشمل
1801 المتلقين زرع الكلى مع تاريخ من التدخين.
تأثير تدخين السجائر على الكلية المتلقي البقاء ليس إلا
تقيمه 6 دراسات و الخطر النسبي عن التدخين الموت
كان متاح في 3 تقارير يتراوح بين 0.8 و 2-2.سيجارة
التدخين هو عامل خطر مستقل وفاة المريض.في
أيضا على univariable وتحليلات multivariable والابتزاز البقاء
ترتبط مع تاريخ من تدخين السجائر و الخطر النسبي
للحصول على طعم الفشل يتراوح بين 1.6 إلى 2-3
الاستنتاجات.تدخين السجائر كان مرتبطا مع زيادة خطر الموت
و طعم الخسارة.ولذلك، ينبغي
كل محاولةلتشجيع زراعة الكلى المرشحين بالتوقف عن التدخين.. 5:141-8
ijkd 2011 www.ijkd. org
مركز أبحاث الكلى و المسالك البولية baqiyatallah
علوم پزشكي تهران، ايران
الكلمات الرئيسية.السجائر, التدخين,
زراعة الكلى، طعم البقاء
مقدمة الوفيات بأمراض القلب والأوعية الدموية التعويضية) هو السبب الرئيسي في الوفيات
بين المتلقين زرع الكلى - 1.2 في
بالإضافة إلىالتدخين هو احتمال كبير للتعديل
أو عوامل الخطر التي يمكن تفاديها CVD. ر بونتيتشلي وما يرتبط بها من
colleagues5 أفادت أن التدخين مع ارتفاع اختطار CVD (الخطر النسبي [ر]، 1-3؛
ع 02) في 864 الكبار المتلقين زرع الكلى
وعلاوة على ذلك، kasiske ووجدت أن coworkers6,7
زرع الكلى المدخنين قد تعاظم خطر مرض القلب الإقفاري (ص ص 1.95) مقارنة
غير المدخنين من المتلقين.المتلقي مدخنين
أقصر بكثير يعني البقاء بسبب
الوفيات الناجمة عن للبخار فيه التدخين لعب
بدور هام في المساهمة - 8.9 في بالإضافة إلى ذلك،
المنشأ عوامل الخطر القلبية الوعائية عدا
التدخين، مثل ارتفاع ضغط الدم، السكري،
الدهون والسمن، هي أكثر شيوعا في الكلية التدخين و زرع الكلى nourbala وآخرون
142 Iranian journal of أمراض الكلى | حجم 5 | | رقم 3 مايو 2011
المتلقين زرع أكثر من عامة السكان.
من عوامل الخطر هذه زيادة اختطار CVD بين المتلقين زرع الكلى انخفاض المريض
و طعم البقاء 10
السرطان السبب الثاني للوفيات في الكلى
المتلقين زرع هو نتيجة أخرى smoking.11 عوامل خطر الخباثة بعد
الزرع تشمل العوامل المشتركة
عامة السكان، مثل العمر، التدخين، exposure.12
والشمس على سبيل المثال، مجموعة من 1500
المتلقين زرع الكلى أظهرت أن عمر أكبر من 45 سنة (ع = - 007) و سيجارة
التدخين (ع = - 02 بشكل كبير) المرتبطة
ارتفاع خطر malignancy.13 في سلسلة من 84
زراعة القلب، تدخين السجائر كان مرتبطا
مع انخفاض المتلقي البقاء وزيادة خطر posttransplant
cancer.14 وأخيراً سيجارة
التدخين هو أيضا عامل خطر رئيسي معروف
تطوير مرض الرئة الانسدادي المزمن,
مع 90 ٪ من الوفيات الناجمة عن انسداد الشعب الهوائية المزمنة أمراض الرئة تعزى مباشرة إلى التدخين 15
ولذلك يمكن للتدخين يؤدي إلى انخفاض المريض
البقاء عن طريق التسبب في أمراض الرئة.انتشار التدخين بين
المتلقين زرع الكلى هو 25 ٪ و 35 ٪ إلى 40 ٪ في
المرضى الأميركية والأوروبية، على التوالي، 16، 17.
من ناحية أخرى، تدخين السجائر في العالم هو سبب رئيسي من أسباب الوفاة المبكرة مسؤولية
ما يقدر بنحو 5 ملايين حالة وفاة كل year.18 على الرغم من الآثار السلبية للتدخين في nontransplant
وضع معروفة، وتأثيرها على المريض
بقاء الطعم بعد زرع الكلى
ما زال غير واضح.هناك، ومع ذلك، من المدهش
الدراسات القليلة التي تتناول تدخين السجائر بين المتلقين زرع الكلى.وبالتالي، أجرينا
إجراء استعراض منهجي الأدب لتحديد آثار التدخين على المريض و طعم
معدلات البقاء على قيد الحياة بين الكليتين المتلقين زرع مواد وأساليب
بحثنا في PubMed قاعدة بيانات من عام 1968 إلى
2009 تحديد دراسات التي أبلغت عن المعنى
من تدخين السجائر على المتلقين زرع الكلى. الكلمات الرئيسية لدينا تشمل زراعة الكلى
السجائر تدخين التبغ و النيكوتين و
المترادفات.إضافية لتحديد المواد ذات الصلة،
المراجع نوعية الموضوع ويستعرض
تحديد المواد كما تم تفتيشها.تتكرر
المنشورات المهملة.ونحن لدينا محدودة
البحث الدراسات الإنسان ولم تضع أية قيود
على اللغة.مراجعة تهدف إلى معالجة اثنين
أسئلة محددة: (1) ما هو تأثير السجائر
التدخين على الكلية آلوگرافت البقاء؟(2) ما هو تأثير التدخين على الكليه
متلقي زرع البقاء؟لا يوجد عدد كاف من case-control الفوج
التقارير والدراسات تعديلها ر و الثقة 95 ٪ 95 ٪
فترات (كوري) of all-cause mortality and طعم الفشل بين زراعة الكلى المدخنين قريب
غير مدخن مريض (الجدول 1)؛ ولذلك فإننا
لا يستطيع تقييم المجمعة المعدلة
للمستهلكين العادية، و 95 ٪ من هذه النهاية التلوي.ويبين الجدول 1
خصائص الدراسات المشمولة في
نتائج هذا الاستعراض. 1,4,8,9,16,17,19-24
ويميلون في البحث اليدوي الإلكتروني 357
عناوين وملخصات الأوراق، منها 39
عدد المرضى السنة أصحاب البلد دراسة التصميم جميع المدخنين
آرند et الأول 1997 هولندا الاستعادية ٨٠٤ ٣٩٤
كوسيو et al8 1999 لنا الاستعادية 523 147
kasiske klinger17 2000 لنا الاستعادية 1334 330
ماتاس et al21 2001 لنا 2540 الاستعادية... *
141
استعراض Iranian journal of أمراض الكلى | حجم 5 | | رقم 3 مايو 2011
تأثير تدخين السجائر على زرع الكلى المستفيدين
مراجعة منهجية محمد حسين nourbala إغليم نعمتی, زهره
بهزاد رستمي، einollahi
مقدمة.تدخين السجائر له آثار سلبية على الكلى
المتلقين زرع، مما تسبب في أمراض القلب والشرايين والكلى
وظيفة البصر،و السرطان.ومع ذلك، هناك عدد قليل من غرابة
دراسات عن آثار تدخين السجائر بين الكليتين
المتلقين زرع ونتائجه بعد زرع
نفذنا مراجعة منهجية الدراسات لتحديد
آثار التدخين على المريض و الطعم معدلات البقاء على قيد الحياة
المواد بين المتلقين زرع الكلى. و الأساليب.بحثنا في مجلات من 1968
في عام 2009، بغية تحديد دراسات على تأثير تدخين السجائر
على المتلقين زرع الكلى، وذلك باستخدام الكلمات التالية:
زراعة الكلى, السجائر, تدخين التبغ و النيكوتين.
ويميلون في البحث اليدوي الإلكتروني 357 مقالة، منها 39
تعتبر ذات الصلة المحتملة من خلال عناوين وملخصات و تم اختيار
كاملا مراجعة النص.سبعة وعشرون أهمية التقارير
استبعدت نتائج
.ما مجموعه 12 ورقة تم اختيارها لإجراء الاستعراض، التي تشمل
1801 المتلقين زرع الكلى مع تاريخ من التدخين.
تأثير تدخين السجائر على الكلية المتلقي البقاء ليس إلا
تقيمه 6 دراسات و الخطر النسبي عن التدخين الموت
كان متاح في 3 تقارير يتراوح بين 0.8 و 2-2.سيجارة
التدخين هو عامل خطر مستقل وفاة المريض.في
أيضا على univariable وتحليلات multivariable والابتزاز البقاء
ترتبط مع تاريخ من تدخين السجائر و الخطر النسبي
للحصول على طعم الفشل يتراوح بين 1.6 إلى 2-3
الاستنتاجات.تدخين السجائر كان مرتبطا مع زيادة خطر الموت
و طعم الخسارة.ولذلك، ينبغي
كل محاولةلتشجيع زراعة الكلى المرشحين بالتوقف عن التدخين.. 5:141-8
ijkd 2011 www.ijkd. org
مركز أبحاث الكلى و المسالك البولية baqiyatallah
علوم پزشكي تهران، ايران
الكلمات الرئيسية.السجائر, التدخين,
زراعة الكلى، طعم البقاء
مقدمة الوفيات بأمراض القلب والأوعية الدموية التعويضية) هو السبب الرئيسي في الوفيات
بين المتلقين زرع الكلى - 1.2 في
بالإضافة إلىالتدخين هو احتمال كبير للتعديل
أو عوامل الخطر التي يمكن تفاديها CVD. ر بونتيتشلي وما يرتبط بها من
colleagues5 أفادت أن التدخين مع ارتفاع اختطار CVD (الخطر النسبي [ر]، 1-3؛
ع 02) في 864 الكبار المتلقين زرع الكلى
وعلاوة على ذلك، kasiske ووجدت أن coworkers6,7
زرع الكلى المدخنين قد تعاظم خطر مرض القلب الإقفاري (ص ص 1.95) مقارنة
غير المدخنين من المتلقين.المتلقي مدخنين
أقصر بكثير يعني البقاء بسبب
الوفيات الناجمة عن للبخار فيه التدخين لعب
بدور هام في المساهمة - 8.9 في بالإضافة إلى ذلك،
المنشأ عوامل الخطر القلبية الوعائية عدا
التدخين، مثل ارتفاع ضغط الدم، السكري،
الدهون والسمن، هي أكثر شيوعا في الكلية التدخين و زرع الكلى nourbala وآخرون
142 Iranian journal of أمراض الكلى | حجم 5 | | رقم 3 مايو 2011
المتلقين زرع أكثر من عامة السكان.
من عوامل الخطر هذه زيادة اختطار CVD بين المتلقين زرع الكلى انخفاض المريض
و طعم البقاء 10
السرطان السبب الثاني للوفيات في الكلى
المتلقين زرع هو نتيجة أخرى smoking.11 عوامل خطر الخباثة بعد
الزرع تشمل العوامل المشتركة
عامة السكان، مثل العمر، التدخين، exposure.12
والشمس على سبيل المثال، مجموعة من 1500
المتلقين زرع الكلى أظهرت أن عمر أكبر من 45 سنة (ع = - 007) و سيجارة
التدخين (ع = - 02 بشكل كبير) المرتبطة
ارتفاع خطر malignancy.13 في سلسلة من 84
زراعة القلب، تدخين السجائر كان مرتبطا
مع انخفاض المتلقي البقاء وزيادة خطر posttransplant
cancer.14 وأخيراً سيجارة
التدخين هو أيضا عامل خطر رئيسي معروف
تطوير مرض الرئة الانسدادي المزمن,
مع 90 ٪ من الوفيات الناجمة عن انسداد الشعب الهوائية المزمنة أمراض الرئة تعزى مباشرة إلى التدخين 15
ولذلك يمكن للتدخين يؤدي إلى انخفاض المريض
البقاء عن طريق التسبب في أمراض الرئة.انتشار التدخين بين
المتلقين زرع الكلى هو 25 ٪ و 35 ٪ إلى 40 ٪ في
المرضى الأميركية والأوروبية، على التوالي، 16، 17.
من ناحية أخرى، تدخين السجائر في العالم هو سبب رئيسي من أسباب الوفاة المبكرة مسؤولية
ما يقدر بنحو 5 ملايين حالة وفاة كل year.18 على الرغم من الآثار السلبية للتدخين في nontransplant
وضع معروفة، وتأثيرها على المريض
بقاء الطعم بعد زرع الكلى
ما زال غير واضح.هناك، ومع ذلك، من المدهش
الدراسات القليلة التي تتناول تدخين السجائر بين المتلقين زرع الكلى.وبالتالي، أجرينا
إجراء استعراض منهجي الأدب لتحديد آثار التدخين على المريض و طعم
معدلات البقاء على قيد الحياة بين الكليتين المتلقين زرع مواد وأساليب
بحثنا في PubMed قاعدة بيانات من عام 1968 إلى
2009 تحديد دراسات التي أبلغت عن المعنى
من تدخين السجائر على المتلقين زرع الكلى. الكلمات الرئيسية لدينا تشمل زراعة الكلى
السجائر تدخين التبغ و النيكوتين و
المترادفات.إضافية لتحديد المواد ذات الصلة،
المراجع نوعية الموضوع ويستعرض
تحديد المواد كما تم تفتيشها.تتكرر
المنشورات المهملة.ونحن لدينا محدودة
البحث الدراسات الإنسان ولم تضع أية قيود
على اللغة.مراجعة تهدف إلى معالجة اثنين
أسئلة محددة: (1) ما هو تأثير السجائر
التدخين على الكلية آلوگرافت البقاء؟(2) ما هو تأثير التدخين على الكليه
متلقي زرع البقاء؟لا يوجد عدد كاف من case-control الفوج
التقارير والدراسات تعديلها ر و الثقة 95 ٪ 95 ٪
فترات (كوري) of all-cause mortality and طعم الفشل بين زراعة الكلى المدخنين قريب
غير مدخن مريض (الجدول 1)؛ ولذلك فإننا
لا يستطيع تقييم المجمعة المعدلة
للمستهلكين العادية، و 95 ٪ من هذه النهاية التلوي.ويبين الجدول 1
خصائص الدراسات المشمولة في
نتائج هذا الاستعراض. 1,4,8,9,16,17,19-24
ويميلون في البحث اليدوي الإلكتروني 357
عناوين وملخصات الأوراق، منها 39
عدد المرضى السنة أصحاب البلد دراسة التصميم جميع المدخنين
آرند et الأول 1997 هولندا الاستعادية ٨٠٤ ٣٩٤
كوسيو et al8 1999 لنا الاستعادية 523 147
kasiske klinger17 2000 لنا الاستعادية 1334 330
ماتاس et al21 2001 لنا 2540 الاستعادية... *
يجري ترجمتها، يرجى الانتظار ..
لغات أخرى
دعم الترجمة أداة: الآيسلندية, الأذرية, الأردية, الأفريقانية, الألبانية, الألمانية, الأمهرية, الأوديا (الأوريا), الأوزبكية, الأوكرانية, الأويغورية, الأيرلندية, الإسبانية, الإستونية, الإنجليزية, الإندونيسية, الإيطالية, الإيغبو, الارمنية, الاسبرانتو, الاسكتلندية الغالية, الباسكية, الباشتوية, البرتغالية, البلغارية, البنجابية, البنغالية, البورمية, البوسنية, البولندية, البيلاروسية, التاميلية, التايلاندية, التتارية, التركمانية, التركية, التشيكية, التعرّف التلقائي على اللغة, التيلوجو, الجاليكية, الجاوية, الجورجية, الخؤوصا, الخميرية, الدانماركية, الروسية, الرومانية, الزولوية, الساموانية, الساندينيزية, السلوفاكية, السلوفينية, السندية, السنهالية, السواحيلية, السويدية, السيبيوانية, السيسوتو, الشونا, الصربية, الصومالية, الصينية, الطاجيكي, العبرية, العربية, الغوجراتية, الفارسية, الفرنسية, الفريزية, الفلبينية, الفنلندية, الفيتنامية, القطلونية, القيرغيزية, الكازاكي, الكانادا, الكردية, الكرواتية, الكشف التلقائي, الكورسيكي, الكورية, الكينيارواندية, اللاتفية, اللاتينية, اللاوو, اللغة الكريولية الهايتية, اللوكسمبورغية, الليتوانية, المالايالامية, المالطيّة, الماورية, المدغشقرية, المقدونية, الملايو, المنغولية, المهراتية, النرويجية, النيبالية, الهمونجية, الهندية, الهنغارية, الهوسا, الهولندية, الويلزية, اليورباية, اليونانية, الييدية, تشيتشوا, كلينجون, لغة هاواي, ياباني, لغة الترجمة.
- WALTERS: You cannot just make a decree t
- لابد ان تتعلمي الطبخ
- قولي لها وهي سوف توافق لان فابي تحبني
- هل تريد مال
- Photos without clothes
- انا معجب
- انعل ابليسك
- NICE PIC
- ان شاء الله م تصيبك عيون
- Photos without clothes
- الان ماذا تعرفين
- No puedo de verdad hay q respetar la des
- كافي واسكت
- يرجى الدخول هنا لترجمة محReferencesتوى
- ماهو السكايب لديك
- Because i don't do this for free
- ممكن أمص لكي لسانك
- هلتعرف ان تطبخ المكرونه لوحدك
- أشعر بالملل قليلا
- هل تعرف ان تطبخ المكرونه لوحدك
- هل يمكنك تصوير لي من مناظر الهند
- ارسل لي صورة ابتسامتك الرائعة
- WALTERS: You cannot just make a decree t
- اعني لازلت اتسكع
