**4. Conclusions**

Lung transplantation has evolved as the gold standard for selective patients with end-stage lung disease but remains limited by a critical donor shortage. Perioperative management of lung transplant recipients is a highly complex endeavor. National registry data reveal progressively improving early as well as long-term survival. Optimal perioperative outcomes are dependent on preemptive, well-coordinated, and multidisciplinary management strategies. Certain high-risk patient subsets with end-stage lung disease such as highly sensitized patients, and those with concomitant severe CAD present unique challenges requiring specialized perioperative management.
