Lung transplantation presents unique perioperative challenges for the anesthesiologist. Preoperative reassessment is essential, as candidates may have deteriorated since their initial evaluation. Anesthetic management must be tailored to accommodate complex comorbidities, often requiring specialized equipment and medications. Sensitized recipients may require intraoperative plasma exchange to mitigate antibody-mediated rejection. Optimal outcomes rely on effective perioperative collaboration among the anesthesiology, surgery, perfusion, and critical care teams.