The lung transplant program at Washington University and Barnes-Jewish Hospital has performed more than 1,000 lung transplants since 1988. The most common operation during this time period has been bilateral-lung transplantation. The LAS has changed lung recipients' diagnoses nationally and at our center. IPF accounts for approximately 25% of recipients at our program and 33% of recipients nationally. Although more severely and acutely ill patients are now coming to transplantation, the long-term outcomes after transplantation have not changed substantially. The incidence of all forms of rejection is high after lung transplantation despite modern immunosuppressive regimens and surveillance techniques. Long-term survival after lung transplantation remains disappointing. In the most recent cohort, the 5-year survival is 64%, but this is significantly worse than survival after kidney, liver, and heart transplantation.