Preface Since the first attempt at human lung transplantation (LTx) by Hardy in the early 1960s, LTx has become an established treatment for a wide variety of end-stage cardiopulmonary diseases. Initially limited to patients with primary pulmonary hypertension or Eisenmenger’s complex, this procedure was extended to patients with a variety of end-stage pulmonary disorders, such as end-stage fibrotic lung disease and end-stage obstructive lung disease as well as suppurative lung disorders, such as bronchiectasis or cystic fibrosis. Problems with bronchial anastomic healing in the immediate postoperative period beleaguered single LTx, but adaptations in surgical approach and the elimination of steroids in the immediate postoperative period led to the successful single LTx for interstitial lung disease in 1983. Subsequently, bilateral LTx was developed, as well as sequential bilateral procedures, with considerable success. A successful LTx is the culmination of a complex and costly series of surgical, medical and social interventions aimed at both prolonging life and enhancing quality of life for the patient with end-stage disease. These rapid advances in patient care could not be possible without the dramatic advances in the understanding of the immune response and the new development of immunological management following transplantation. Better understanding of the mechanisms of ischaemia/reperfusion injury as well as improvements in the techniques of lung preservation have contributed to a reduction in the incidence of ischaemia/reperfusion-induced lung injury and the development of primary graft failure after LTx. A future challenge will be to improve the number of donor lungs available for transplantation, since improvement in the quality of donor lungs can have a tremendous impact on the number of transplants performed and on the success of LTx. Indeed, so long as the lack of suitable lung donors remains a significant problem, LTx will be limited to a minority of patients with end-stage lung disease This issue of the European Respiratory Monograph offers the reader excellent state-of- the-art information regarding experiences with LTx four decades after the first procedure. Increased physician awareness of LTx by discussion of the possibilities of organ donation, especially in the critical care setting, may also help to offer new perspectives for those patients suffering from otherwise fatal lung pathologies. E.F.M. Wouters Editor in Chief Eur Respir Mon, 2003, 26, a. Printed in UK - all rights reserved. Copyright ERS Journals Ltd 2003 European Respiratory Monograph ISSN 1025-448x. ISBN 1-904097-29-4. a