Compared to alcohol use, and despite its potential health implications, tobacco use among candidates and recipients of orthotopic liver transplantation (OLT) has not been the focus of much attention. The purpose of the present study is to examine lifetime pre- and post-OLT prevalence rates of tobacco use, relapse rates after OLT, and comorbid use of alcohol and tobacco. Structured interviews were conducted to examine retrospective accounts of lifetime tobacco use in 202 OLT recipients. Sixty percent of OLT recipients reported a lifetime history of smoking, with 15% reporting smoking post-OLT. Of smokers who quit before OLT, 20% reported relapse to smoking post-OLT. Finally, 54% reported using both tobacco and alcohol pre-OLT. In light of these prevalence data and known health risks associated with tobacco use, there is an urgent need to examine the relationship between tobacco use and OLT outcomes. Furthermore, assessment of tobacco use and the provision of treatment for nicotine dependence should be a routine part of OLT candidacy evaluations and follow-up, based on general medical risk factors and potential relevancy to patient and graft survival.