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.