&NA;Lung transplantation is one of the most challenging operations an anesthesiologist can face. The patient's condition in the preoperative state is often rather tenuous. Pulmonary hypertension either exists preoperatively or can easily occur intraoperatively. Despite improvements in preservation techniques, reperfusion injury of the donor lung remains an issue. The anesthesiologist must attempt to minimize any rise in pulmonary artery pressures through the use of intravenous agents or inhaled nitric oxide and judicious fluid administration. Prophylactic attempts to minimize reperfusion injury must also be undertaken.