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.