Impact of donor smoking history on post heart transplant outcomes: A propensity‐matched analysis of ISHLT registry

Purpose Smoking is a major public health issue, and its effect on cardiovascular outcomes is well established. This study evaluates the impact of donor smoking on heart transplant (HT) outcomes. Methods HT recipients between January 1, 2005, and December 31, 2016, with known donor smoking status were queried from the International Society of Heart and Lung Transplantation (ISHLT) registry. The primary outcome was all‐cause mortality, and secondary endpoints were graft failure, acute rejection, and cardiac allograft vasculopathy. We utilized propensity‐score matching to identify cohorts of recipients with and without a history of donor smoking. Hazard ratios for post‐transplant outcomes for the matched sample were estimated from separate Cox proportional hazard models. Results Of 26 390 patients in the cohort, 18.9% had history of donor smoking. Donors with history of smoking were older, predominantly male and had higher incidence of diabetes, hypertension, cocaine use, and "high‐risk" status. In propensity‐matched analysis, recipients with a history of donor smoking had increased risk of death (HR 1.11, 95% CI 1.03‐1.20) and higher risk of graft failure (HR 1.11, 95% CI 1.03‐1.20). Conclusion Donor smoking was associated with increased mortality and higher incidence of graft failure following HT. Consideration of donor smoking history is warranted while evaluating donor hearts.