Introduction

Lung transplantation has evolved over the last 30 years from an experimental procedure to a proven therapeutic intervention for a wide variety of end-stage parenchymal and vascular disorders in infants, children and adults. Guthrie and Carrel first demonstrated the technical feasibility of the method over a century ago in a heterotopic procedure in which the heart and lungs of a kitten were implanted in the neck of a cat. Early experimental work is credited to the Russian physiologist, Petrovich Demikhov, although much of his work remained in obscurity until recently. The first human lung transplant was performed by Hardy and colleagues at the University of Mississippi in 1963 but the recipient survived only 18 days before succumbing to multiorgan failure. Cooley et al. performed the first combined heart-lung transplant in a 2-month-old infant with complex congenital heart disease. The child survived 14 hours and died of respiratory failure. Between 1963 and 1980, 38 more combined transplant procedures were performed but few patients survived more than a few days or weeks. Reitz and colleagues at Stanford University developed the first successful combined heart and lung transplant program in the early 1980s. Advanced pulmonary vascular disease including idiopathic pulmonary arterial hypertension and complex congenital heart disease with Eisenmenger's physiology were indications for this procedure. Four of the five patients survived beyond a 6-month period of follow-up. Single lung and double lung (including bilateral sequential single lung procedures) transplant programs became established later in that decade. Lung transplantation in the pediatric population was introduced in 1986 and the first procedure in an infant was reported in 2000. The living-related lobar transplant program was developed by Starnes and colleagues in the mid-1990s and has more recently been expanded to cadaveric lobar lung transplantation.