Benden C, Inci I, Weder W, Boehler A. Size-reduced lung transplantation in children - an option worth to consider! Pediatr Transplantation 2009: 00: 000-000. (c) 2009 John Wiley & Sons A/S. Abstract: Lung transplantation is an accepted therapy for pediatric end-stage lung disease. However, there is a shortage of suitable donor organs. Therefore, the use of downsized lung allografts seems a valuable option. We report our experience of downsized pediatric lung transplantation in comparison with standard full-size pediatric lung transplantation over one decade. Pediatric recipients undergoing downsized or standard lung transplantation were included (January 1997-December 2006). We compared pretransplant clinical data and surgical and post-operative complications and post-transplant outcome. Ten pediatric lung transplants were performed (median patient age 15.6 yr [12.3-17.8]). Nine of 10 patients had CF. Five patients underwent standard full-size lung transplantation; five had downsized lung transplants. "Downsized" recipients had significantly lower median height and weight Z-scores. Donor/recipient length difference was significantly greater in the "Downsized" Group (p < 0.05). All patients had comparable post-transplant functional outcome without additional surgical complications or morbidities in "downsized" recipients. Median post-transplant survival was 65 months (5-77) in the "Standard" Group compared to 86 months (64-121) in the "Downsized" Group (p = 0.1). Our data suggest that downsized lung transplantation in pediatric recipients may have post-transplant outcomes comparable to full-size lung transplantation without significant complications.