Pediatric lung transplantation

The first human lung transplantation (LT) was performed by Hardy in 1963; however, it was not until the early 1980s that challenges related to rejection and healing of the airway anastomoses were successfully overcome. Interest in offering such potential life-saving interventions to children was kindled by success in adults; the first pediatric LT was performed at the University of Toronto in 1987. Now into a third decade, LT and heart–lung transplantation (HLT) have become accepted therapies for end-stage pulmonary disease in children. As of June 2009, 1400 LT and more than 500 HLT in pediatric recipients have been reported to the Registry for the International Society for Heart and Lung Transplantation (ISHLT). After dropping from more than 80 in the late 1990s to below 70 in the early 2000s, the number of pediatric LTs per year has risen steadily and exceeded 100 for the first time in 2008 (Figure 20.1). Interestingly, the steady increase likely reflects increases outside the United States, as the number of transplants performed there has remained steady in recent years.