Tobacco use persists after liver transplant for alcoholic liver disease

Alcohol and tobacco often go hand-in-hand. Studies have shown that approximately 90 percent of problem drinkers also smoke or chew tobacco. But tobacco use is not adequately addressed when patients undergo liver transplantation due to alcoholic liver disease, say authors of a new report.

Published in the June 2005 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS), the report found--after a prospective study of 172 such patients--a need for more stringent monitoring of tobacco use in liver transplant populations and call for more intervention. The journal is available online via Wiley InterScience.

Little data is available on tobacco consumption among transplant recipients, but researchers had previously found high death rates from lung cancer and oropharyngeal cancers among patients who had received a liver transplant due to alcoholic liver disease and they believed tobacco to be the cause.

To test this hypothesis, researchers, led by Andrea DiMartini, M.D. of the University of Pittsburgh, investigated post-transplant tobacco use among 172 patients who received a liver transplant as a result of alcoholic liver disease (ALD). They asked patients to complete questionnaires about their health habits--including the Fagerstrom Test for Nicotine Dependence--every three months in the first post-transplant year, and every 6 months for the next two years. The researchers then analyzed the responses in relation to demographic data.

"The results show a disturbing trend in our ALD population," the authors report. "A significant percent (39-58 percent across time points) use tobacco post-liver transplant." They found that most smokers resumed their habit quickly and their consumption increased over the first post-transplant year. Nearly 50 percent of those who smoked at all post-transplant were found to be nicotine dependent.

Only a few associations were found between smoking and demographic and medical characteristics in the transplant population. Recipients who also had hepatitis B virus or hepatitis C virus were more likely to smoke, as were those with a history of abusing substances (beyond alcohol). Patients who had been alcohol-dependent pre-transplant were also more likely to smoke. The researchers did not find an association between depressive symptoms and smoking. They intend to continue following the population to investigate the associations between tobacco use and post-liver-transplant morbidity and mortality.

Compared to statistics that show just 10 to 15 percent of liver transplant recipients return to alcohol abuse, the high rates of smoking are worrisome and may be due to the lack of "a concerted approach to tobacco use," say the authors.

"Considering all associations between tobacco use and poor health outcomes, tobacco use may well outweigh alcohol use for impact on post-liver transplant morbidity and mortality," they conclude. "Tobacco use has become the next compelling issue for liver transplant candidates and one of the most important indications for treatment after liver transplant."