One hundred and fifty-nine combined heart and lung transplantations were performed on 152 patients at Harefield Hospital from 1980 to February 1988. The age of the recipients ranged from 10 weeks to 52 years. The transplantation was indicated for pulmonary vascular disease on 106 patients (69.7 per cent), and for parenchymal lung disease on 46 patients (30.3 per cent). Eisenmenger syndrome was the commonest disease that required the heart-lung transplantation. A combination of cyclosporin A and azathioprine was administered for immunosuppression therapy postoperatively, and oral steroids were not routinely used. The hospital mortality rate was 32.2 per cent, and 103 patients were discharged from the hospital. The first-year actuarial survival rate was 64 per cent, and the second-year was 61 per cent. Although pulmonary deterioration due to obliterative bronchiolitis was a serious late complication, most of the recipients enjoyed a good quality of life after transplantation. Heart and lung transplantation offers the patient a chance of marked improvement both in survival and in quality of life.