[Present statues of lung transplantation (author's transl)]

It is difficult to sum up the justifications for pulmonary transplantation in man as out of 34 cases carried out up to now only the patient DEROM, has survived 10 months. In fact, analysis shows that all of the other cases cannot be taken into consideration, as there were technical problems, or the receivers were nearly in the threws of death and this was the case of the patient SALVATOR. Two important problems remain to be resolved: First of all that of obtaining grafts in good condition. In fact the sole source of donors remains irreversible comas, and it is known that after 24 hours of artificial respiration the lung has undergone irreparable damage. It is therefore necessary to develop a reliable method for preservation. Present experimental results show that lungs preserved for 48 hours and regrafted into other animals are not only functional, in the immediate, but the scintigraphic scanning graphs after a month, are comparable with those in control animals. Studies of coagulation have demonstrated that pulmonary rejection is characterised before infiltration by mononuclear cells, by major coagulation disorders. In the treated animals, rejection crises are preceded a few days earlier by hypercoagulability and a fall in circulating platelets. These findings have enabled one, by the addition of appropriate anti-coagulant treatment, to overcome the rejection crises- without any other therapy than the basic classical treatment- (Immuran + corticosteroids). Under these conditions, the few specialised centres are therefore authorised to again attempt human pulmonary transplantation.