Objectives: Blood transfusion is associated with higher morbidity and mortality after general cardiothoracic surgery but little is known of the impact on the transplant population. We investigated the profile of blood product transfusion in the bilateral lung transplant (BLT) population and the impact on function and survival outcomes.Methods: A total of 311 adult patients who underwent BLT between 2003 and 2013 were retrospectively reviewed. Patients were stratified according to pretransplant diagnosis and amount of blood products transfused within 24 h of surgery.Results: Patients, 174 male, 137 female (mean age 41.4 ± 14.0 years) underwent BLT, using cardiopulmonary bypass for cystic fibrosis (48.87%), fibrotic lung disease (12.21%), emphysema (27.01%), bronchiectasis (5.79%), pulmonary hypertension (1.29%) and others (4.50%). Median number of red blood cells (RBC) in the first 24 h was 3 (0–40) units, fresh frozen plasma (FFP) was 2 (0–26) units, platelets = 1 (0–7) units. There were no differences in transfusion rates according to pretransplant diagnosis. Patients were divided according to the number of units transfused in the first 24 h. Survival was not influenced by whether patients were transfused with more or less than the median number of units of RBC (P = 0.162) or FFP (P = 0.298) (Fig. 1). However, survival was adversely affected by platelet transfusion (P = 0.032). Mean FEV1 at 6 months was significantly better for patients transfused with more than the median number of units of RBC (2.66 vs 2.83, P <0.0001), FFP (2.61 vs 2.89, P <0.0001) and platelets (2.73 vs 2.82, P <0.0001).Conclusion: Unlike general cardiothoracic surgery, blood transfusion has no effect on survival, but administration of platelets has an adverse effect. Blood product administration does not differ significantly with pretransplant diagnosis. Interestingly, lung function at 6 months is significantly better for patients with transfusion with more blood products.