Lung transplantation provides very good short- and acceptable long-term survival for patients with advanced lung disease. More widespread use of marginal and distant donors can be employed in selected recipients without compromising early or late results. Lack of suitable donor lungs and the development of BOS represent the biggest obstacles to more widespread application and long-term success of lung transplantation. The high rate of acute rejection and subsequent BOS clearly indicates that current immunosuppression strategies are inadequate. Further clinical and laboratory research into the pathogenesis of BOS will perhaps reveal new treatment options.