[Lung transplantation]

Lung transplantation has been made possible by the advent of cyclosporin, and it can be divided into three categories: single lung, double lung and heart-lung transplantations. Heart-lung transplantation is the only one that can be performed in case of primary pulmonary arterial hypertension, but the respective indications of these three types of transplantation in patients with respiratory failure have not yet been clearly determined. Heart-lung transplantation is also the one that gives the best results in terms of survival and respiratory function. In the post-operative period, graft rejection and bacterial, viral, fungal or parasitic infections are responsible for a 35 per cent death rate. Later in life, transplant recipients are prone to respiratory impairment caused by obliterating bronchiolitis, itself due to insufficiently treated chronic rejection. The development of lung transplantation is considerably limited by the scarcity of donors with procurable lungs and by the frequency of heart procurement at the expense of the heart-lung block.