LUNG TRANSPLANTATIONS - 15 YEARS ON

After fifteen years of experience, 3-year survival rates after lung tr ansplantation have reached 60% for heart-lung, two-rung and single-lun g procedures. At 7 years, the rate is currently 41%. Lung transplantat ion has thus become the ultimate treatment for end-stage respiratory f ailure, and, as we were able to establish in 1988, single rung transpl antation is now the indication of choice. Most of the early complicati ons after transplantation, including edema and post-operative shock th ough relatively frequent can generally be controlled. There is however the problem of acute rejection during the first three months followin g transplantation due to herpes or cytomegalovirus infections which re spond poorly to antiviral therapy. Immunosuppresive therapy generally can control acute rejection, but subsequent chronic episodes may accou nt for 25% of long-term failures. Episodes of chronic rejection usuall y occur after nine months but onset may be retarded beyond 3 years. Th e real problem today is the small number of donors and the long waitin g lists. In France, where 200 lung transplantations are needed annuall y the number of donors is dramatically insufficient.