At Osaka University, we have performed 83 brain-dead donor (BDD) lung transplants, 11 bilateral living donor lobar lung transplants, and 3 combined heart-lung transplants. Survival rates in the BDD group for 5 and 10 years were 77.0% and 6.07% in single lung transplantation (N = 43), and 80.8% and 80.8% in bilateral lung transplantation (N = 35), respectively. There were 8 long-term survivors of beyond 15 years, and late death in this group only developed in single lung transplantation. From these results, the superiority of bilateral lung transplantation has been confirmed. We have also done 3 combined heart and lung transplantation in 3 patients, and all are alive up to 16 years post-transplant. The characteristics of our practices in lung transplantation show a high frequency of combined repair of intracardiac lesions and also pulmonary artery hypertension. Here, we discuss chronic lung allograft dysfunction, role of surveillance bronchoscopy for acute rejection in relation to chronic lung allograft dysfunction (CLAD), and donor pool expansion by introducing transplantation from the donors after circulatory death.