Reliability of self-reported nicotine use as determined by serum cotinine levels in patients referred for liver transplantation

Background: Smoking has been associated with a higher incidence of post-hepatic transplantation de novo noncutaneous neoplasms and vascular complications. There are conflicting reports regarding increased posttransplant mortality. Objective: The authors sought to determine the reliability of patient-reported nicotine product use (NPU) in candidates for hepatic transplantation. Method: The authors performed a retrospective chart review of all patients referred for liver transplantation in a 12-month period. Each patient's report of recent or current nicotine product use through smoking, chewing tobacco, or nicotine replacement products, as obtained in interviews, was compared with the quantitative result of serum cotinine levels. Results: Of 171 patients referred for liver transplant evaluation during a 12-month period, 17% reported ongoing NPU, and 83% denied it. Of the patients who denied recent NPU, 11% had serum cotinine levels reflective of active use. Of the patients reporting active NPU, 97% had positive cotinine levels. Conclusion: There was a high degree of reliability of patient self-reported NPU, but detecting deceptive reporting is important in the selection of patients who will have long-term success with liver transplantation.