Cystic fibrosis (CF) is a genetic condition that is caused by abnormalities in the CF transmembrane conductance regulator ( CFTR ) gene. People with CF experience life-long morbidity and premature mortality, the vast majority of which is associated with lung disease. Bile acids are detectable in the lower airway in advanced CF lung disease and persist after lung transplantation We gratefully acknowledge the help of the patients involved in this study along with all members of the wider cardiothoracic transplantation team at the Freeman Hospital.