Induction immunosuppression (IIS) has increased in the modern era of pediatric lung transplant (LTx), but research on early outcomes is limited. The aims of this study were to: 1) describe the effect of IIS on 1-year mortality/graft failure/re-LTx, and 2) describe the effect of IIS on 1-year infection and rejection. Using the ISHLT Registry, we reviewed all pediatric (<18y) primary LTx from 2005-2017. Donor/recipient characteristics and 1-yr outcomes (death/graft failure/re-LTx), rejection, and infection were analyzed. Recipients who received IIS and those who did not were compared using non-parametric tests. Further subanalyses were performed examining outcome differences between IIS agents (depleting vs. non-depleting). Multivariable logistic regression was used to assess primary and secondary endpoints. Of 684 primary pediatric LTxs, 432 (63%) received IIS (32% depleting vs. 68% non-depleting). Median age was 14 (range: 0-17 yrs) and 43% were males. The primary endpoint of death or graft failure/re-LTx by 1-year occurred in 13% of patients (15% IIS vs 11% no IIS, p=0.1). There was no difference between groups regarding at least 1 rejection episode (26% IIS vs. 26% no IIS, p=0.9), or at least 1 admission for infection (53% IIS vs. 58% no IIS, p=0.36) in the first post-LTx year. In the IIS subgroup, there was no difference in incidence of rejection within 1 year between depleting and non-depleting IIS (24% vs 26%, p=0.79). However, non-depleting IIS was associated with a higher incidence of infection compared to depleting IIS (58% vs 40%, p=0.007). In the multivariable analysis, PRA>25% (OR 4.4, 95% CI: 1.04-18.6) and rejection in 1-year (OR 2.6, 95% CI: 1.2-5.6) were the only independent variables associated with death, graft failure/re-LTx. Infection requiring treatment 2 weeks prior to LTx (OR 1.7, 95% CI: 1.1-2.7), corticosteroids as IIS (OR 2.0, 95% CI: 1.3-3.2), and life support at time of LTx (OR 2.1, 95% CI: 1.2-3.7) were independently associated with infection within the first year. Age was the only variable independently associated with rejection in the first year (OR 1.09, 1.04-1.1). There appears to be no early outcome advantage for IIS in primary LTx in children, while our subanalyses identified potential risks for recipients of non-depleting agents. Future analyses will focus on which pediatric LTx groups may benefit from IIS.