Pediatric Lung Transplantation M. Solomon, MD, FRCPC a,b, *, H. Grasemann, MD, PhD a,b , S. Keshavjee, MD, MSc, FRCSC a,c HISTORICAL NOTES Compared with transplantation of other organs, lung transplantation is a young field that continues to grow. Lung transplantation is an important treatment option in children with acquired or congenital lung diseases. The first human lung transplantation was attempted in 1963 by Hardy, as reported in the New England Journal of Medicine, 1 but the world’s first long-term successful lung transplantation was achieved in Toronto in 1983. Successful heart-lung transplantation and lung transplantation in adults during the early 1980s were followed by the application of lung transplantation in the pediatric population. The first reported pediatric lung transplant occurred in Toronto in 1987 in a 16-year-old boy with familial pulmonary fibrosis, 2 which, along with other early reports of success in children, led to an increased use of this procedure in children. From 1986 to June 2008, 1278 pediatric lung transplant and 549 heart-lung transplant procedures were reported to the registry of the International Society of Heart & Lung Transplant (ISHLT). 3 The number of lung transplantations performed annually has varied between 20 and 87. In 2007, 93 pediatric lung transplant and 8 heart-lung transplant procedures were reported. To date, this is the highest number of pediatric lung trans- plants reported in a single year to this registry. According to the 2009 ISHLT Registry report, there are 36 centers worldwide that perform lung transplants in children. These numbers suggest that each center performs 2 to 3 transplants per year on average. In fact, 1 center reported 10 to 19 transplants per year, 3 centers reported 5 to 9 transplants per year, and the remainder performed 4 or fewer procedures annually. a Toronto Lung Transplant Program b Department of Pediatrics, Division of Respiratory Medicine and Transplant Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada c Division of Thoracic Surgery, Toronto General Hospital, 200 Elizabeth Street, 9N-946, Toronto, ON M5G 2C4, Canada * Corresponding author. Department of Pediatrics, Division of Respiratory Medicine and Transplant Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada. E-mail address: melinda.solomon@sickkids.ca KEYWORDS  Lung transplantation  Pediatrics  Bronchiolitis obliterans  Cystic fibrosis  Pulmonary hypertension Pediatr Clin N Am 57 (2010) 375–391 doi:10.1016/j.pcl.2010.01.017 pediatric.theclinics.com 0031-3955/10/$ – see front matter Crown Copyright ª 2010 Published by Elsevier Inc. All rights reserved.