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Tobacco and liver transplantation: From medicine to surgery

Herrero et al. have confirmed that active smoking is independently associated with a higher risk of malignancy after liver transplantation. Unfortunately, in contrast to alcohol, the level of concern about this deadly addiction remains low: only 1 series is available. Before transplantation, 17% of patients are active smokers (the rate is 52% for patients with alcoholic liver disease), and only one-third of these patients succeed in quitting. It is likely that too few hepatologists are concerned about the early identification of patients who smoke and provide assistance to those who are trying to stop smoking. There is no excuse: in addition to all its deadly effects on health, smoking is an independent and doserelated factor contributing to hepatocellular carcinoma.