Spontaneous pneumothorax of native lung after single lung transplantation is a rare but well-known complication. Four cases of spontaneous pneumothorax after single lung transplantation in our patients are presented, primary lung disease was emphysema in 3 patients and idiopathic pulmonary fibrosis in 1. In 3 cases, pneumothorax was treated successfully with chest tube; in 1, pneumonectomy was needed for the management of a persistent air leak. Two patients died later of progressive chronic rejection; 1 had unexplained sudden death. One patient is well 8 years posttransplantation. Our experience of spontaneous pneumothorax of native lung after single lung transplantation demonstrated that this rare complication occurs more in patients with emphysema. This complication is successfully treated with standard therapy, but these patients are prone to other fatal complications such as bronchiolitis obliterans or sudden death.