As of October 1990, the Registry of the International Society for Heart Transplantation has received data on over 14,000 heart and over 1,100 combined heart-lung or lung transplant recipients from over 200 centers worldwide. While the areas of single-lung transplantation and pediatric heart transplantation continue to expand rapidly, further growth in annual numbers of cardiac and pulmonary transplant procedures is now limited by donor supply. Operative mortality and late survival have improved during the past decade, however, infection and rejection continue to be the main causes of death. As the number of long-term survivors continues to increase, chronic rejection remains the major obstacle and results with retransplantation have not been very encouraging.