Worldwide, about 40% of lung transplantations (LTx) are performed for end-stage emphysema [1]. Eligible patients are enrolled on the waiting list after at least 6 months of smoking cessation [1]. Although in most centres smoking behaviour after LTx is not routinely monitored, resuming smoking can complicate post-transplant outcome [2-5]. In general, smoking relapse can be found in 12-40% of all liver, heart and renal transplant patients [3]. Smoking is mostly assessed by use of a questionnaire. Only the study of Botha et al. [4] combined a questionnaire with urinary cotinine detection.
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