Lung transplantation presents unique anesthetic and surgical challenges across complex patient populations. In cystic fibrosis, meticulous airway management and infection control are critical due to copious secretions and multidrug-resistant organisms. Single lung transplantation requires nuanced ventilation strategies to avoid native lung hyperinflation or injury to the graft. Bridging with V-V ECMO demands careful anticoagulation and hemodynamic vigilance. Lung transplant for COVID-ARDS hinges on candidate selection and timing. Combined heart-lung transplants require coordinated, multi-specialty approaches throughout cardiopulmonary bypass. Redo transplantation carries higher risks due to adhesions, coagulopathy, and prolonged operative time.