[Lung transplantation: the current state of knowledge]

The modern era of lung transplantation followed the introduction of cyclosporin and the development of en bloc heart-lung transplantation in 1980. This was followed in 1983 by the first long-term successful unilateral lung transplant by the Toronto group. The same group carried out the first successful double lung transplantation in 1986. Heart-lung transplantation remains the most common operation for patients with end-stage lung disease but is being gradually replaced by single lung transplantation for end-stage pulmonary hypertension, pulmonary fibrosis and emphysema. The major indication for double lung transplantation is cystic fibrosis or emphysema in subjects less than 45 years of age. The probability of survival after lung transplantation is approximately 65% after one year and 60 and 50% after two and three years respectively. This compares favorably to the early results obtained with heart transplantation. These survival figures represent a marked improvement in the prognosis of patients with end-stage lung disease who are candidates for lung transplantation since such subjects should have an expected survival of less than two years without this intervention. The major problems encountered with lung transplantation are technical difficulties during the operation, serious infections and acute episodes of rejection, both of which are most common in the first six months following the operation, and bronchiolitis obliterans, which is a late complication most probably related to chronic rejection. Organ availability remains a major limiting factor to the availability of lung transplantation and, as a consequence, numerous patients die while awaiting a donor organ.