Pediatric lung transplant was born at the University of Toronto as an extension of the pioneering work of Cooper and Patterson in adult lung transplant in the 1980s. Through the 1990s, the field of pediatric lung transplantation grew with clinical outcomes in the largest centers being comparable to those in adult lung transplantation. For children and adults, the largest obstacle to long-term survival remains chronic allograft rejection secondary to the development of bronchiolitis obliterans, for which little advancement has been made in prevention or treatment. While transplantation has become accepted therapy for end-stage lung disease in adults, pediatric lung transplant has been less widely embraced for multiple reasons, such as adolescent non-compliance and the investment required in developing freestanding pediatric lung transplant centers. Another factor limiting pediatric lung transplant has been the paucity of suitable donor lungs. In 2002, Texas Children's Hospital and the Baylor College of Medicine successfully collaborated in developing an active and successful pediatric lung transplant program. Through our own work and an international collaborative of pediatric transplant pulmonologists and surgeons, we are hoping to move the field of pediatric lung transplant out of its "adolescence" into adulthood.