Purpose of review Respiratory failure remains the most common complication in the perioperative period after lung transplantation. Consequently it is important to develop an approach to diagnosis and the treatment of respiratory failure in this population. This review highlights the advances made in the understanding and treatment of lung transplant patients in the early postoperative phase. Owing to its relative importance, advances in the understanding and treatment of ischaemia-reperfusion

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... jury are highlighted. Recent findings The causes of respiratory failure and the complications seen after transplantation are time dependent, with ischaemiareperfusion, infection, technical problems and acute rejection being the most common in the early perioperative phase, and obliterative bronchiolitis, rejection, and infections secondary to bacteria, fungi, and viruses becoming more prevalent after 3 months. The advances in lung preservation and postoperative care may be overshadowed by an increase in the complexity of the recipients and the use of more marginal organs. An improved mechanistic understanding of ischaemiareperfusion injury has translated into potential therapeutic targets. The development of prospective clinical trials, however, is hampered by a relatively small sample of patients and a significant degree of heterogeneity in the lung transplant population. Summary Many advances have been made in the understanding of ischaemia-reperfusion injury. Owing to the acute and longterm implications of this complication, interventions that reduce the risk of developing ischaemia-reperfusion need to be evaluated in prospective clinical trials.