Significant improvements in operative technique, immunosuppression, and treatment of infections have led to higher 1-year lung transplant recipient survival than in the past. Favorable outcome is dependent on the early functional recovery of the transplanted lung. Routine perioperative management includes respiratory support, preemptive antimicrobial therapy, chest tube management, and hemodynamic and cardiovascular monitoring. When functional recovery of the transplanted lung is delayed, recipient survival is dependent on aggressive supportive respiratory management. A thorough understanding of the tempo and presentation of perioperative respiratory complications that are unique to this population is important in their early diagnosis and management Pulmonary venous obstruction, rejection, and infection must be excluded. In the presence of graft failure, supportive measures such as independent lung ventilation, extracorporeal membrane oxygenation, and retransplantation should be considered.