To identify the respiratory problems of renal transplant recipients (RTRs) who were admitted to a single center’s intensive care unit (ICU) during long-term follow-up. Incidence rates of respiratory problems diagnosed at or after admission were determined, and mortality associated with these complications was investigated. The medical charts of all RTRs who were admitted to the Baskent University Hospital ICU from January 2000 through December 2003 were retrospectively studied. The data collected for each case were demographic features, interval from transplantation to ICU admission, need for and duration of mechanical ventilation, APACHE II score, respiratory indications for ICU admission, respiratory problems that developed during the ICU stay, and ICU mortality. Pleural effusion, pneumonia, pulmonary atelectasis, pulmonary edema, pneumothorax, and respiratory failure were the respiratory problems diagnosed. Thirty-four patients had a total of 39 ICU admissions for respiratory and non-respiratory medical issues. The mean patient age was 35±13 years, the mean time from transplantation to ICU admission was 35±40 months, and the mean APACHE II score was 25±9. The frequency of requirement for mechanical ventilation was 62%, and the mean duration of ventilation in these cases was 112±168 hours. Twenty-four patients (61.5% of total) had at least one respiratory problem at admission or developed one during their ICU stay. The most frequent of these problems was pneumonia (n=18, 46.2% of the 39 patients), followed by acute respiratory failure (n=10, 25.6%), atelectasis (n=9, 23.1%), pleural effusion (n=8, 20.5%), pulmonary edema (n=2, 5.2%), and pneumothorax (n=1, 2.6%). The overall mortality rate was 51.2% (20 patients). The patients who had respiratory problems had a significantly higher mortality rate than those who did not have respiratory problems (66.6% vs 26.6%, respectively; p<0.05). For RTRs admitted to the Baskent University Hospital ICU during long-term follow-up, infectious and respiratory problems are the most frequent indications for admission and are also the most common problems to develop during an ICU stay. The prognosis for RTRs who have respiratory problems at admission to ICU or develop one during an ICU stay is poor.