Transplant Trial Watch

Smoking and outcomes in kidney transplant recipients: a post hoc survival analysis of the FAVORIT trial.

Weinrauch LA, Claggett B, et al.

International Journal of Nephrology & Renovascular Disease 2018; 11: 155-164.


Aims
To determine the effect of smoking status on clinical outcomes in kidney transplant recipients.

Interventions
The study is a post hoc analysis of the international FAVORIT trial*. The associations between smoking status, defined as never having smoked, formerly or currently smoking, and both all cause mortality and graft survival were assessed using Cox proportional hazards models.

Participants
4110 FAVORIT trial transplant recipients who had received kidney allografts ≥ 6 months previously, with stable graft function but elevated plasma homocysteine levels.

Outcomes
Measured outcomes included all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, cardiovascular morbid events, loss of allograft function (retransplantation) or kidney failure (return to dialysis).

Follow-up
Mean of 3.8 years

CET Conclusions
This paper presents a post-hoc multivariate analysis of the FAVORIT study. This analysis investigated the relationship between smoking status and outcome. The paper is well written and appropriate methods have been used. Continued smoking amongst patients with stable kidney allografts was associated with significantly increased mortality (HR=1.70) and this difference was largely due to an increase in non-cardiac death rates (primarily infections). Current smoking was also associated with a significantly increased risk of graft loss (HR=1.49). Interestingly smoking was associated with increased cardiovascular events, but not cardiovascular deaths. This publication supports the previously published observational studies.

Jadad score
5

Data analysis
Per protocol analysis

Allocation concealment
Yes

Quality notes
Previously assessed as *Bostom AG, et al. Homocysteine-lowering and cardiovascular disease outcomes in kidney transplant recipients: primary results from the Folic Acid for Vascular Outcome Reduction in Transplantation Trial. Circulation. 2011; 123(16): 1763–1770.

Trial registration
ClinicalTrials.gov - NCT00064753

Funding source
Non-industry funded