This chapter addresses aspects of lung transplantation (LT) that are unique to infants, children, and adolescents. The primary diagnoses leading to LT in the pediatric age group are cystic fibrosis (CF) and pulmonary hypertension, either idiopathic or related to congenital heart disease. The main difference in surgical technique relates to the increased use of bypass. The vast majority of pediatric LT recipients receive two lungs; for those with CF and other suppurative diseases, the decision is based on the infection risk. Transbronchial biopsies (TBBx) are also more challenging in pediatrics, particularly in infants and toddlers. Graft failure and infection are important causes of death in the first year after transplant. In pediatrics, as few centers perform enough transplants each year to adequately power outcome studies, uniform treatment strategies and multi-center collaborations helps to identify strategies for earlier diagnosis and allow assessment of treatment efficacy.

Heart transplantation has excellent long-term survival, with 50% of patients living 10 years, and significant improvement in quality of life. Various factors contribute to increased early graft failure and morality, including changing donor and recipient profiles in recent years. Changes in recent years that have improved very long-term survival include modern immunosuppression, statin use, systematic post-transplant care/surveillance, and better management of renal dysfunction. The long-term complications following heart transplantation are similar to those of other organ transplants and include vasculopathy and complications of immunosuppressants. Coronary artery vasculopathy (CAV) is a leading cause of graft failure. The incidences of various metabolic syndrome risk factors including hypertension, obesity, diabetes mellitus, and hyperlipidemia are increasingly seen after heart transplantation. Acute and chronic renal failures are common after heart transplantation. Malignancy is a major cause of late morbidity and mortality after heart transplantation. Involvement of psychological and psychiatric support is important following heart transplantation.