MILAN—Smoking increases the risk for graft failure and death among renal transplant recipients, investigators have concluded.

Researchers at the University Medical Center Groningen in the Netherlands led by Stephan J.L. Bakker, MD, determined the smoking status of 604 renal transplant recipients at a mean six years post-transplant.

At inclusion in the study, 133 recipients (22%) were current smokers, 255 (42%) smoked in the past, and 216 (36%) never smoked. Among past smokers, 210 (82%) stopped smoking before transplantation. During a mean follow-up of 5.3 years, graft failure occurred in 42 subjects (7%) and 95 (16%) died.

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Compared with patients who never smoked, current smokers were at threefold increased risk for graft failure after adjusting for age, gender, creatinine clearance, and proteinuria, the researchers reported here at the World Congress of Nephrology. Graft failure risk was not increased in past smokers.

Additionally, current and past smokers were at twofold higher risk of death than subjects who never smoked.

The finding that past smoking is a risk factor for death but not graft failure suggests that atherosclerosis of the native vasculature plays no role in the association between smoking and graft loss, the researchers said.

“It is advisable for renal transplant recipients to quit smoking, preferably before transplantation, but otherwise, after transplantation,” said Dr. Bakker, Associate Professor of Internal Medicine.

“Although smoking cessation after transplantation seemingly does not affect the risk of dying, our findings indicate that it is beneficial for preservation of renal function.”