Impact of Cigarette Smoking among Living Donors on Kidney Transplant Graft Survival
In brief
Kidney grafts from donors with smoking history had 13% higher loss risk
In 88,490 living-donor kidney transplants, any donor smoking history was associated with 13% higher risk of graft loss; donors who were still smoking had greater risk than former smokers. The highest risk appeared with more than 20 pack-years, but this retrospective study cannot show that smoking caused graft loss or determine how donor history should guide transplant decisions.
- Journal
- Kidney360 (Q1)
- Published
- 1 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Machi Kaneko McBee, Daniel J Tancredi, Lavjay Butani
- PMID
- 42821333
- DOI
- 10.34067/KID.0000001402
Why clinicians should know about it
- Picked for Nephrology (paper of the day, 4 October 2026): Living donor smoking linked to graft loss risk
Abstract
BACKGROUND: Current evidence on the impact of living donor smoking on kidney transplant outcomes is conflicting. This study aimed to evaluate the association between living donor smoking history and graft survival. We hypothesized that any donor smoking history is associated with increased risk of graft loss, but this risk is attenuated with donor smoking cessation, lower pack-year history and longer duration of smoking abstinence. METHODS: We conducted a retrospective cohort study using the Organ Procurement and Transplantation Network database, including 88,490 individuals who underwent living donor kidney-only transplantation between June 2004 and June 2022. The exposure was living donor smoking history (ever vs never, former vs active, pack-year history, years of abstinence)The primary outcome was all-cause graft loss, analyzed using multivariable Cox proportional hazard models. Secondary outcomes of delayed graft function and first year acute rejection were analyzed using multivariable logistic regression. RESULTS: Recipients of organs from donors with any smoking history had an increased risk of all-cause graft loss (HR: 1.13 [1.09-1.16], p<0.001) and first year acute rejection (OR: 1.18 [1.11-1.25], p<0.001). Compared to never smokers, both active and prior smoking in the donor was associated with a higher hazard of graft loss (HR:1.19 [1.13-1.25] and 1.10 [1.07-1.14], respectively, both p<0.001), with higher hazard in active vs. prior (p=0.02). Grafts from donors with >20 pack-year smoking history experienced the highest risk of graft loss (HR: 1.29 [1.21-1.37], p<00.1), delayed graft function (OR: 1.24 [1.03-1.49], p=0.001), and acute rejection (OR: 1.31 [1.16-1.50], p<0.001). CONCLUSIONS: Cigarette smoking in living kidney donors is associated with modest increase in a risk for all-cause graft loss, with the greatest risk observed among recipients of grafts from donors with a significant pack-year smoking history.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.