<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_sjph-2016-0005_s_398_w2aab3b8c12b1b7b1aab1c15b1Aa"><h3>Introduction</h3><p>Smoking is associated with a higher incidence of post-lung transplantation complications and mortality. Prior to inclusion on the lung transplant waiting list in the Czech Republic, patients are supposed to be tobacco free for at least 6 months. Our aim was to determine the prevalence of smoking, validated by urinary cotinine, among patients post lung transplantation and prior to inclusion on the transplant waiting list.</p></sec><sec id="j_sjph-2016-0005_s_400_w2aab3b8c12b1b7b1aab1c15b2Aa"><h3>Methods</h3><p>Between 2009 and 2012, we conducted a cross-sectional survey of urinary cotinine to assess tobacco exposure in 203 patients in the Lung Transplant Program in the Czech Republic. We measured urinary cotinine in 163 patients prior to inclusion on the transplantation waiting list, and 53 patients post bilateral lung transplantation.</p></sec><sec id="j_sjph-2016-0005_s_401_w2aab3b8c12b1b7b1aab1c15b3Aa"><h3>Results</h3><p>5.1% (95% CI 0.078 to 0.269) of all lung transplant recipients had urinary cotinine levels corresponding to active smoking; and a further 3.8% (95% CI 0.007 to 0.116) had borderline results. Compared to patients with other diagnoses, patients with COPD were 35 times more likely to resume smoking post-transplantation (95% CI 1.92 to 637.37, p-value 0.016). All patients who tested positive for urinary cotinine levels were offered smoking cessation support. Only one Tx patient sought treatment for tobacco dependence, but was unsuccessful.</p></sec><sec id="j_sjph-2016-0005_s_403_w2aab3b8c12b1b7b1aab1c15b4Aa"><h3>Conclusion</h3><p>Smoking resumption may be an underrecognized risk for lung transplantation recipients, particularly among patients with chronic obstructive pulmonary disease. More rigorous screening, as well as support and treatment to stop smoking among these patients are needed.</p></sec></abstract>

IntroductionSmoking is associated with a higher incidence of post-lung transplantation complications and mortality. Prior to inclusion on the lung transplant waiting list in the Czech Republic, patients are supposed to be tobacco free for at least 6 months. Our aim was to determine the prevalence of smoking, validated by urinary cotinine, among patients post lung transplantation and prior to inclusion on the transplant waiting list.MethodsBetween 2009 and 2012, we conducted a cross-sectional survey of urinary cotinine to assess tobacco exposure in 203 patients in the Lung Transplant Program in the Czech Republic. We measured urinary cotinine in 163 patients prior to inclusion on the transplantation waiting list, and 53 patients post bilateral lung transplantation.Results5.1% (95% CI 0.078 to 0.269) of all lung transplant recipients had urinary cotinine levels corresponding to active smoking; and a further 3.8% (95% CI 0.007 to 0.116) had borderline results. Compared to patients with other diagnoses, patients with COPD were 35 times more likely to resume smoking post-transplantation (95% CI 1.92 to 637.37, p-value 0.016). All patients who tested positive for urinary cotinine levels were offered smoking cessation support. Only one Tx patient sought treatment for tobacco dependence, but was unsuccessful.ConclusionSmoking resumption may be an underrecognized risk for lung transplantation recipients, particularly among patients with chronic obstructive pulmonary disease. More rigorous screening, as well as support and treatment to stop smoking among these patients are needed.

Continued Smoking in Lung Transplant Patients: A Cross Sectional Survey

Department of Orthopaedics and Traumatology, Regional Hospital Kolín, Kolín 280 02,

Center for Tobacco-Dependence, 3rd Medical Department – Department of Endocrinology and Metabolism, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Prague 128 21,

Department of Forensic Medicine and Toxicology, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague 128 21,

3rd Department of Surgery, 1st Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague 121 08,

Department of Pneumology, 2nd Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague 150 06,

Slovenian Journal of Public Health

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

NADALJNJE KAJENJE PRI PACIENTIH PO PRESADITVI PLJUČ: PRESEČNA ŠTUDIJA

IntroductionSmoking is associated with a higher incidence of post-lung transplantation complications and mortality. Prior to inclusion on the lung transplant...

Characteristics	Pre–WL (N=163)	Post-Tx (N=53)
Gender (% male)	67%	62%
Age (years) (mean ± SD)
CF group	30.66 ± 10.90	28.68 ± 8.81
Non-CF group	56.28 ± 8.69	54.38 ± 8.88
Medical Diagnosis (%)
COPD group	69 (42.3%)	26 (49.1%)
Non-COPD group	94 (57.7	27 (50.9%)

Urinary cotinine concentrations (ng/ml)	Pre–WL (N=163)	Post-Tx (N=53)
Negative	89.0% (145/163)	81.1% (43/53)
(< 50 ng/ml)	95% CI 0.821 to 0.921	95% CI 0.685 to 0.893
Borderline	6.1% (10/163)	3.8% (2/53)
(50 ≤ X < 500 ng/ml)	95% CI 0.033 to 0.108	95% CI 0.007 to 0.116
Positive	4.9% (8/163)	15.1% (8/53)
(≥ 500 ng/ml)	95% CI 0.078 to 0.094	95% CI 0.025 to 0.269

Urinary cotinine levels	COPD-group (n= 94)	Non-COPD group (n= 122)
Pre-WL
Negative	81.2%	94.7%
(< 350 ng/ml)	(56/69)	(89/94)
Positive and Borderline	18.8%	5.3%
(≥ 50 ng/ml)	(13/69)	(5/94)
Odds ratio	4.13
95% Cl	1.40 to 12.22
P-value	0.010
Post-Tx
Negative	61.5%	100%
(< 50 ng/ml)	(16/26)	(27/27)
Positive and Borderline	38.5%	0%
(≥ 50 ng/ml)	(16/26)	(27/27)
Odds ratio	35.00
95% Cl	1.92 to 637.37
P-value	0.016

Continued Smoking in Lung Transplant Patients: A Cross Sectional Survey

Article Category: Original scientific article

Published Online: Mar 10, 2016

Page range: 29 - 35

Received: Mar 23, 2015

Accepted: Sep 03, 2015

DOI: https://doi.org/10.1515/sjph-2016-0005

Keywords
smoking, transplantation, lung

© National Institute of Public Health, Slovenia

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Demographic characteristics of lung transplant recipients’ post-transplantation and prior to the inclusion on the transplant waiting list in the Czech Republic 2009-2012.

Urinary cotinine concentrations of lung transplant (Tx) patients post-Tx and prior to the inclusion on the waiting list in the Czech Republic 2009-2012. 80% of all patients one year post-Tx were tested in the observed period.

The comparison of urinary cotinine levels among patients with COPD & Emphysema and patients with other diagnoses post-lung Tx and prior to inclusion on the Tx waiting list.

Continued Smoking in Lung Transplant Patients: A Cross Sectional Survey

Article Category: Original scientific article

Published Online: Mar 10, 2016

Page range: 29 - 35

Received: Mar 23, 2015

Accepted: Sep 03, 2015

DOI: https://doi.org/10.1515/sjph-2016-0005

Keywordssmoking, transplantation, lung

© National Institute of Public Health, Slovenia

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Demographic characteristics of lung transplant recipients’ post-transplantation and prior to the inclusion on the transplant waiting list in the Czech Republic 2009-2012.

Urinary cotinine concentrations of lung transplant (Tx) patients post-Tx and prior to the inclusion on the waiting list in the Czech Republic 2009-2012. 80% of all patients one year post-Tx were tested in the observed period.

The comparison of urinary cotinine levels among patients with COPD & Emphysema and patients with other diagnoses post-lung Tx and prior to inclusion on the Tx waiting list.

Keywords
smoking, transplantation, lung