[Present international status and basic approach of lung and heart-lung transplantation]

Lung transplantation has been established as an optional treatment for variable irreversible diffuse lung diseases. To date, more than 5,000 patients have underwent lung transplantation, and nearly 1,000 procedures a year are performed recently. Although heart-lung transplantation has also been technically established, this procedure is confined to quite limited conditions due to the severe shortage of donors and many difficulties in operative procedure and the patient management. Preservation, post-transplantation edema, diagnosis of rejection, chronic rejection, shortage of donor organs, are principal problems in clinical lung transplantation, 24-hour preservation proved to be possible in several recent experimental studies, and the reperfusion injury has been revealed to be one of causes of post-transplantation edema. Establishment of methods for long-term pulmonary preservation and for the treatment of post-transplantation edema may be promising in the near future. Shortage of donor lung is one of major limiting factors. Research works on xenotransplantation and cadaver lung transplantation are on going, and these may help in solving this problem.