[Pulmonary transplantations. Current assessment].

After fifteen years of experience, 3-year survival rates after lung transplantation have reached 60% for heart-lung, two-lung and single-lung procedures. At 7 years, the rate is currently 41%. Lung transplantation has thus become the ultimate treatment for end-stage respiratory failure, and, as we were able to establish in 1988, single lung transplantation is now the indication of choice. Most of the early complications after transplantation, including edema and post-operative shock, though relatively frequent, can generally be controlled. There is however the problem of acute rejection during the first three months following transplantation due to herpes or cytomegalovirus infections which respond poorly to antiviral therapy. Immunosuppressive therapy generally can control acute rejection, but subsequent chronic episodes may account for 25% of long-term failures. Episodes of chronic rejection usually occur after nine months but onset may be retarded beyond 3 years. The real problem today is the small number of donors and the long waiting lists. In France, where 200 lung transplantations are needed annually, the number of donors is dramatically insufficient.