Pathology of the transplanted heart and lung.

Combined heart-lung transplantation is now being carried out in many centers around the world. Single-lung and double-lung transplantation are being done in only a few centers and are still considered to be experimental procedures. Combined heart-lung transplantation has been performed successfully in adults and in small children and offers a definite therapeutic alternative to such diseases as severe congenital heart disease with pulmonary hypertension, cystic fibrosis, and primary pulmonary hypertension. At present, the survival statistics for this procedure are similar to those for heart transplantation 15 years ago; it is hoped that, as with heart transplantation, survival rates will improve with better management and more reliable diagnosis of acute rejection, in order to prevent the insidious and relentless onset of obliterative bronchiolitis, which is now the most significant limiting factor to the success of long-term survival in heart-lung transplantation.