INTRODUCTION
Pediatric lung transplantation has been performed in selected centers
for three decades, and it is today an accepted therapy in carefully
selected pediatric candidates with progressive pulmonary and pulmonary
vascular disease, delivering an overall survival benefit and improved
health-related quality of life 1-5. More than 100 lung
transplant procedures are performed in the pediatric age group per year
worldwide according to the most recent Thoracic Transplant Registry
Report of the International Society for Heart and Lung Transplantation
(ISHLT) 6. Pediatric lung transplants are performed
predominately at North American centers; in Europe, leading pediatric
lung transplant programs are located in Hannover, London, and Vienna.
However, the majority of centers in North America, Europe and Australia
do five or fewer pediatric lung transplants per year and mostly
candidates older than age five years 6. Overall,
cystic fibrosis (CF) is the most common underlying disease in pediatric
lung transplantation 6. In children between one and 10
years of age, CF and idiopathic pulmonary arterial hypertension (IPAH)
are the most common underlying primary indications for lung
transplantation. Overall, IPAH is the second most frequent indication
for children requiring lung transplantation, and in children aged one to
five years IPAH and other forms of PH are the most common indication6.
In general, pediatric lung transplant is an exceedingly complex
medical-surgical endeavor requiring a multidisciplinary approach and
close interdisciplinary collaboration. The surgical approach is often
challenging due to previous surgery, the pre-transplant morbidities of
the transplant candidates and the frequency of imperfect donor-recipient
lung size matching. Additionally, overseeing and modulating
immunosuppression in infants and children with developing immune systems
with frequent viral infections is imposing. In addition, psychosocial
aspects are potential hurdles to achieve good outcomes, particularly in
adolescents 1.