[Lung transplantation and cystic fibrosis]

It is only in 1983-84 that lung transplantation has been contemplated in cystic fibrosis patients. The French programme, reported here, began in 1987. The criteria of inclusion are detailed, including antibiotic dependence, oxygen dependence, poor spirometric profile, destabilized nutritional status and very low Shwachman's score. The hepatic, cardiac, pulmonary, gastrointestinal, endocrine and psychological situations leading to temporary or definitive exclusion are defined. Once this evaluation has been made, the patients to be put on the waiting list are chosen collegially. The principles of medical and surgical treatment are exposed: immunodepressants and anti-infectious agents are prescribed to get over the immediate postoperative period (rejection and infectious complications) and to prevent the constitution of the much feared bronchiolitis obliterans; the indications of surgical techniques (HLT and BPT) should be more accurate. Among the 100-150 cases of lung transplantation recorded in the world, 30 were performed in France. We can safely say that 70 p. 100 of these patients are still alive and 40 p. 100 are in a remarkably good condition. This overall view is both exciting and disappointing, considering the results obtained and the ever-increasing waiting lists (more than 100 cases in France); hence the need for improving the present programme side by side with genetic and therapeutic studies which will eventually make surgery unnecessary.