The first human lung transplantation was performed by Dr. lames Hardy at the University of Mississippi in 1une 1963 (l). Between 1963 and 1974, 36 patients underwent lung transplantation at medical centers around the world, but only two recipients lived longer than 1 mo (2). After this disappointing start, there was a hiatus in clinical lung transplantation until the introduction of cyclosporine ushered in the era of solid organ transplantation that began in the early 1980s. Beginning in 1981, heart-lung transplantation (HLT) was performed for pulmonary vascular disease; single lung transplantation (SLT) for pulmonary fibrosis followed in 1983and double lung transplantation for obstructive lung disease in 1986 (3-5). The successes in the 1980s were a preclude to the resurgence of lung transplantation in the 1990s. In this decade, lung transplantation has come of age (6). Activity has expanded rapidly, and the results have been good. However, the limitations have become apparent. This article will review the state of the art in lung transplantation with an emphasis on clinical aspects.