title: Continued Smoking in Lung Transplant Patients: A Cross Sectional Survey.
abstract: BACKGROUND
  Smoking is associated with a higher incidence of post-lung transplantation complications and mortality. Prior to inclusion on the lung transplant waiting list in the Czech Republic, patients are supposed to be tobacco free for at least 6 months. Our aim was to determine the prevalence of smoking, validated by urinary cotinine, among patients post lung transplantation and prior to inclusion on the transplant waiting list.
  
  
  METHODS
  Between 2009 and 2012, we conducted a cross-sectional survey of urinary cotinine to assess tobacco exposure in 203 patients in the Lung Transplant Program in the Czech Republic. We measured urinary cotinine in 163 patients prior to inclusion on the transplantation waiting list, and 53 patients post bilateral lung transplantation.
  
  
  RESULTS
  15.1% (95% CI 0.078 to 0.269) of all lung transplant recipients had urinary cotinine levels corresponding to active smoking; and a further 3.8% (95% CI 0.007 to 0.116) had borderline results. Compared to patients with other diagnoses, patients with COPD were 35 times more likely to resume smoking post- transplantation (95% CI 1.92 to 637.37, p-value 0.016). All patients who tested positive for urinary cotinine levels were offered smoking cessation support. Only one Tx patient sought treatment for tobacco dependence, but was unsuccessful.
  
  
  CONCLUSIONS
  Smoking resumption may be an underrecognized risk for lung transplantation recipients, particularly among patients with chronic obstructive pulmonary disease. More rigorous screening, as well as support and treatment to stop smoking among these patients are needed.
authors.affiliation: Department of Orthopaedics and Traumatology, Regional Hospital Kolín, Kolín 280 02, Czech Republic.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Zmeškal
authors.affiliation: Center for Tobacco-Dependence, 3rd Medical Department - Department of Endocrinology and Metabolism, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Prague 128 21, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Králíková
authors.affiliation: Department of Forensic Medicine and Toxicology, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague 128 21, Czech Republic.
authors.forename: Ivana
authors.initials: I
authors.lastname: Kurcová
authors.affiliation: 3rd Department of Surgery, 1st Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague 121 08, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Pafko
authors.affiliation: 3rd Department of Surgery, 1st Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague 121 08, Czech Republic.
authors.forename: Robert
authors.initials: R
authors.lastname: Lischke
authors.affiliation: Department of Pneumology, 2nd Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague 150 06, Czech Republic.
authors.forename: Libor
authors.initials: L
authors.lastname: Fila
authors.affiliation: Department of Pneumology, 2nd Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague 150 06, Czech Republic.
authors.forename: Lucie
authors.initials: L
authors.lastname: Valentová Bartáková
authors.affiliation: Center for Tobacco-Dependence, 3rd Medical Department - Department of Endocrinology and Metabolism, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Prague 128 21, Czech Republic.
authors.forename: Keely
authors.initials: K
authors.lastname: Fraser
keywords: lung; smoking; transplantation