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Orthotopic transplantation of the pig heart is described, with success in the last 12 of 23 studies, leading to survival until rejection in the last two. The pig heart was found to be easily damaged by cold. In contrast, organ viability was not appreciably affected when the warm ischaemic time was shortened by making the aortic anastomosis the initial manaeuvre of implantation. The advantages of the pig as a model for the study of orthotopic cardiac allografts would appear to be its tolerance of long periods of cardiopulmonary bypass, immediate c'otting after heparin reversal and ability to maintain the circulation without drug or pacemaker support. These factors have contributed to the relative simplicity of post-operative management.

SummaryThe transplantation of the right lung into a man aged 40 who was suffering from cryptogenic fibrosing alveolitis is described. Before transplantation he had been dependent on oxygen, even at rest, for 24 hours a day for almost two years. The donor was a boy of 16 years who had had a fatal cerebral haemorrhage. The transplanted lung functioned perfectly from the time of operation until the patient's sudden death two months later from an overwhelming haemoptysis apparently from a small peribronchial abscess rupturing into the pulmonary artery. By the third postoperative week the patient had been able to walk unaided and without distress outdoors. The problem of differentiating infection from incipient rejection is discussed. We conclude that clinically successful lung transplantation can be achieved, but only if the problems of lung function, infection, and immunosuppression can all be overcome.

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Unless by your skill you can prevent the formation of a stricture you are presiding at the opening of a life-long tragedy. (RUTHERFORD MORISON.)

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