Objectives: Lung transplantation is currently the ultimate treatment option for patients with end-stage lung disease refractory to medical treatment. In reviewing our 4-year experience we sought to evaluate complications and survival after sequential bilateral lung transplantation. Methods: From October, 2008 to June, 2012, we performed 18 lung transplantation procedures. Underlying lung diseases were idiopathic pulmonary fibrosis in 6 patients; toxic inhalation injury in 5; post-bone marrow transplantation bronchiolitis obliterance in 3; acute respiratory distress syndrome in 2; lymphangioleiomyomatosis in 1, and angiosarcoma in 1. Data for all patients were collected and analyzed retrospectively. Procedures were carried out using standardized protocols. Results: Thirteen patients underwent double lung and five heart-lung transplantations. Among them, 12 patients (66.7%) underwent high-emergency lung transplantation. Early complications were prolonged air leak, vocal cord palsy, critical illness polyneuropathy, necrotizing pancreatitis, and renal failure requiring dialysis. Late complications consisted of airway complications (n=6), gastro-intestinal complications (n=7), diabetes mellitus (n=2), osteopenia (n=2), and post-transplantation lymphoproliferative disorders (n=1). There was no peri-operative death. Two patients (11.1%) died from 6 and 8 months after lung transplantation, because of the infection. Conclusion: We conclude that lung transplantation is a viable option for selected patients with end-stage lung disease refractory to medical treatment.