BACKGROUND Pulmonary disorders are common in patients with advanced heart failure (HF). In this study we sought to evaluate the findings detected on pre and postoperative assessment of heart failure patients who underwent orthotopic heart transplantation (OHT). METHODS The records of 30 patients with advanced HF who underwent OHT at our center were evaluated. Clinical and demographic characteristics, laboratory and radiological findings were noted. Pulmonary function tests (PFTs) and cardiopulmonary exercise testing (CPET) results were obtained. RESULTS The mean age was 31.0+/-16.8 years and 7 were female. History of smoking was present in 15 (50%) patients. PFTs revealed normal findings in 50%, obstructive pattern in 26.7%, restrictive in 16.7% and mixed pattern in 6.6% of the patients. CPET was performed to 17 patients. Mean peak VO2 of the patients was 11.5+/-4.9 ml/kg/min and mean VO2 at anaerobic threshold was 10.9+/-3.5 ml/kg/min. The mean left ventricular ejection fraction on the postoperative first week was 46+/-11%. The mean extubation time was 80.4 hours. Postoperative pulmonary complications were developed in 11 (36.7%) patients. Postoperative pneumonia was observed in 5 (16.7%) cases. Thoracentesis was performed to 7 patients with large pleural effusion, which was transudative in 5 and exudative in 2 patients. Thoracentesis culture was positive in 2 cases. Mortality was observed in 7 patients. CPET and PFTs results were found to have no significant effect on postoperative pulmonary complications and mortality (P>0.05). CONCLUSIONS These findings indicate that pulmonary disorders are frequent in patients with advanced heart failure waiting heart transplantation, and following heart transplantation pulmonary complications are common. Further prospective researches with larger patient numbers are needed to determine risk factors for postoperative pulmonary complications in patients undergoing heart transplantation.