Donor tobacco smoking is associated with postoperative thrombosis after primary liver transplantation

BACKGROUND: Thrombosis after liver transplantation is a leading cause of graft loss, morbidity, and mortality. Several known recipient‐ and surgery‐related characteristics have been associated with increased risk of thrombosis after transplantation. Potential donor‐related risk factors, however, remain largely undefined. OBJECTIVES: We aimed to identify risk factors for early post‐transplantation thrombosis (<90 days) and to determine the impact of early postoperative thrombosis on long‐term graft and patient survival. PATIENTS/METHODS: A post hoc analysis was performed of an observational cohort study including all primary, adult liver transplantations performed between 1993 and 2018. Donor‐, recipient‐, and surgery‐related characteristics were collected. Competing risk model analyses and multivariable regression analyses were performed to identify risk factors for developing early post‐transplant thrombosis and graft failure. RESULTS: From a total of 748 adult liver transplantations, 58 recipients (7.8%) developed a thrombosis after a median of 7 days. Post‐transplantation thrombotic events included 25 hepatic artery thromboses, 13 portal vein thromboses, and 22 other thrombotic complications. Donor history of smoking was independently associated with early postoperative thrombosis (odds ratio [OR] 2.42; 95% confidence interval [CI], 1.29‐4.52). Development of early post‐transplant thrombosis was independently associated with patient mortality (hazard ratio [HR] 3.61; 95% CI 1.54‐8.46) and graft failure (HR 5.80, 95% CI 3.26‐10.33), respectively. CONCLUSION: Donor history of smoking conveys a more than two‐fold increased risk of thrombosis after liver transplantation, independent of other factors. Post‐transplant thrombosis was independently associated with decreased patient and graft survival.