The effect of smoking on biliary complications following liver transplantation

Amit K. Mathur, David N. Ranney, Shaun P. Patel, Dennis S. Lee, Filip Bednar, Raymond J. Lynch, Theodore H. Welling, Michael J. Englesbe

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


We sought to estimate the effect of smoking on the biliary complication rate following orthotopic liver transplantation. We retrospectively evaluated the records of liver transplant recipients at our center from July 1, 1999 to October 26, 2007. Using Cox proportional hazards models, we estimated the time to the earliest biliary complication (leak or stricture) based on smoking exposure, as active, former, or lifetime nonsmoker, adjusting for other clinical factors. Overall, 409 liver transplant recipients were evaluated. The overall biliary complication rate was 37.7% (n = 154). Biliary complications included 66 anastomotic leaks, 60 anastomotic strictures, and 28 nonanastomotic lesions. ERCP was the primary diagnostic modality (n = 112). 18.1% of liver transplant recipients were active smokers (n = 74) and 42.8% were former smokers (n = 175). Active smokers were at greatest risk for biliary complications on unadjusted analysis (P = 0.022). After multivariable adjustment, active smokers had a 92% higher rate of biliary complication rates compared with lifetime nonsmokers (HR 1.92, 95% CI 1.07-3.43), but no difference was noted in the rate of complication resolution. Smoking clearly portends a significant risk of biliary complications following liver transplantation. Smoking status should be clearly defined when evaluating transplant candidacy and in counseling patients with cirrhosis.

Original languageEnglish (US)
Pages (from-to)58-66
Number of pages9
JournalTransplant International
Issue number1
StatePublished - Jan 2011

All Science Journal Classification (ASJC) codes

  • Transplantation

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