Anabasine Is a Poor Marker for Determining Smoking Status of Transplant Patients

[摘要] To the Editor:Current clinical practice guidelines in the transplant setting necessitate the complete cessation of smoking to be considered a candidate for listing on the United Network for Organ Sharing (UNOS).1 The negative health consequences of smoking are well documented, as are the adverse outcomes in donors and recipients of solid organs who smoke, particularly in cases involving the lungs (1). Transplantation programs therefore rely heavily upon the laboratory to carry out the analysis and interpretation of tobacco screening assays to ensure abstinence in patients as part of the evaluation for listing in UNOS.Nicotine and its primary metabolite cotinine are the two most commonly monitored compounds to determine smoking status in patients. Nicotine is rapidly metabolized in vivo to cotinine, which has a much longer half-life (20 h vs 2 h), and therefore substantially extends the detection window (2). Ambiguity can arise however if a patient is using nicotine replacement therapy (NRT; nicotine-containing gums or patches as well as the vapor pens). These products contain nicotine and therefore produce positive nicotine and cotinine results, which can potentially prohibit patients from receiving a life-saving organ. To address this issue several reference laboratories have developed mass spectrometry–based assays for detection …

[学科分类] 过敏症与临床免疫学