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World J Transplant. Apr 24, 2017; 7(2): 129-133
Published online Apr 24, 2017. doi: 10.5500/wjt.v7.i2.129
Smoking in Renal Transplantation; Facts Beyond Myth
Ahmed Aref, Ajay Sharma, Ahmed Halawa
Ahmed Aref, Department of Nephrology, Sur hospital, Sur 411, Sultanate of Oman
Ahmed Aref, Ajay Sharma, Ahmed Halawa, Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3GB, United Kingdom
Ajay Sharma, Royal Liverpool University Hospital, Liverpool L7 8XP, United Kingdom
Ahmed Halawa, Sheffield Teaching Hospital, University of Sheffield, Sheffield S5 7AU, United Kingdom
Author contributions: Aref A contributes by designing the work, data collection, writing the manuscript; Sharma A reviewed and edited the manuscript; Halawa A contributes by choosing the topic of our work, reviewing and final editing of the manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other co-authors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Ahmed Halawa, Consultant Transplant Surgeon, Sheffield Teaching Hospital, University of Sheffield, Herries Road, Sheffield S5 7AU, United Kingdom. ahmed.halawa@sth.nhs.uk
Telephone: +44-77-87542128 Fax: +44-11-42714604
Received: September 30, 2016
Peer-review started: October 10, 2016
First decision: December 1, 2016
Revised: December 18, 2016
Accepted: February 28, 2017
Article in press: March 2, 2017
Published online: April 24, 2017
Processing time: 202 Days and 17.8 Hours
Abstract

Smoking is one of the preventable leading causes of death worldwide. Most of the studies focused on the association between smoking and cardiovascular disease, pulmonary diseases, malignancy and death. However, the direct effect of smoking on the renal system was undermind. There are emerging evidence correlating tobacco use with pathological changes in the normal kidneys. The effect is more obvious on the renal allograft most probably due to the chronic immune suppression status and the metabolic effect of the drugs. Several studies have documented a deleterious effect of smoking on the renal transplant recipients. Smoking was associated with lowering patient and graft survival. Smoking cessation proved to improve graft survival and to a lesser extent recipient survival. Even receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries a poorer graft survival compared to non-smoking donors. Most of the studies investigating the effect of smoking were based on self-reporting questioners, which may be misleading due to poor recall or the desire to give socially acceptable answers. This made the need of a reliable biomarker of ultimate importance. Cotinine was proposed as a promising biomarker that may help to provide objective evidence regarding the status of smoking and the dose of nicotine exposure, yet there are still some limitations of its use. The aim of this work is to review the current evidence to improve our understanding of this critical topic. Indeed, this will help to guide better-designed studies in the future.

Keywords: Smoking; Kidney donor; Kidney recipient; Renal transplantation

Core tip: There are several studies addressing the effect of smoking on different body systems, yet, there are only few exploring the effect of smoking on the outcome of renal transplantation. Our present article summarizes all the available data published over the past 2 decades for better understanding of this topic and may also guide future studies.