A study conducted at the University of Maryland School of Medicine in Baltimore provides the first direct evidence that cigarette smoke exposure previous to a heart transplant in either the donor, recipient, or both, accelerates the death of a transplanted heart. The study, published this month in the journal Circulation, showed that tobacco smoke leads to accelerated immune system rejection of the transplanted heart, heightened vascular inflammation and increased oxidative stress, and a reduction in the transplanted organ's chance of survival by 33-57 percent.