Advancing Lung Transplantation.

Lung transplantation rapidly evolved from an experimental to a conventional therapy for patients with end-stage lung disease. In recent years, approximately 4,000 lung transplants are performed annually worldwide. A shortage of suitable donor organs remains the main obstacle to increasing transplant volume. In addition, long-term outcomes remain disappointing, and the median survival after transplantation is approximately 6 years. Chronic rejection has clearly emerged as the leading obstacle to better outcomes beyond the first year after transplantation. This generally follows a progressive and relentless course culminating in allograft failure and death. Consequently, there is a critical need for strategies that delay or prevent the development of chronic rejection, and better treatments that halt the progression of chronic rejection. The impact of novel interventions is best assessed in the context of multi-center randomized controlled trials.