Smoking, a Perioperative Risk Factor for Patients undergoing Thoracic Organ Transplantation

Tobacco smoke consists of thousands of toxic substances that may disturb normal physiologic processes, thereby compromising transplantation outcomes. Tobacco use reduces the immune response, especially in the lungs, promotes arteriosclerosis, increases the risk for cardiovascular diseases and delays wound healing. These negative effects lead to an increased risk of smokers for perioperative complications, especially pulmonary outcomes, disturbed wound healing and wound infections. Active smoking is a contraindication for cardiac as well as lung transplantation and smoking resumption after transplantation increases morbidity and mortality of transplant recipients. Therefore, the assessment of the smoking status and referral to competent cessation services should be incorporated into standard operating procedures, including medical history taking, pre- and postoperative care of thoracic transplantations.