Lung transplantation has become an effective therapeutic option in patients with end stage lung disease. Patients undergoing lung transplantation present a variety of challenges to the anesthesia team. This retrospective study describes anesthesia management in patients underwent lung transplantation during a 5 year period in Dr. Masih Daneshvari Hospital, Tehran, Iran. There were 16 patients of lung transplant recipient from June 2003 to April 2008. Of them 13 patients underwent single lung transplantation (SLT) (8 fibrosis, 1 pulmonary alveolar microlithiasis, 1 scleroderma, 2 emphysema, and 1 silicosis) and 3 bilateral sequential lung transplantation (DLT) (2 bronchiectasis and 1 emphysema). Anesthesia was induced with sodium thiopental or fentanyl and midazolam and atracurium or cisatracurium were used for muscle relaxation. Anesthesia was maintained with isoflurane or propofol and remifentanil continuous infusion in O2 100% (8 cases received total intravenous anesthesia and 8 balanced anesthesia techniques). Systemic arterial pressure, arterial blood gases and central venous pressures were monitored throughout the surgery, along with inspired and expired gases and airway pressure. Lung isolation was accomplished by using Robertshaw double lumen endotracheal tube. Nitroglycerin (TNG), prostaglandin E1, dopamine, dobutamine, epinephrine, and noreepinephrine were used for hemodynamic management. The patients received mechanical ventilation, immunosuppressive drugs, antibacterial prophylaxis, and prevention of reperfusion injury in the ICU postoperatively. Recipients were 11 male and 5 female with a mean age of 38.5 ± 13 yrs. In 4 cases (2 SLT and 2 DLT) cardiopulmonary bypass was used because of hemodynamic instability and hypoxemia. Permissive hypercapnia was used in 10 cases. Intraoperative death was observed in one patient due to technical difficulty of surgical procedure. The average extubation time was 34.86 ± 17 hours after surgery. It is hoped that lung transplantation will be made available to a greater number of patients with end stage pulmonary disease in Iran. Continued advancements in perioperative monitoring, pulmonary vasodilators and technical considerations improve perioperative anesthetic management of lung transplantation.