*Purpose: Induction therapy is used in about more than 80% of lung transplant centers and is increasing globally. Currently, there are no standards or guideline for induction therapy. We are one of the few centers in the world that use both basiliximab and alemtuzumab induction and we would like to share our experience and practice since this is an area of controversy.

*Methods: We retrospectively reviewed 840 lung transplants performed at our institution between 2011 and 2020. Indications for the use of the basiliximab protocol were as follows: patients over the age of 70 years, history of cancer, hepatitis C virus or human immunodeficiency virus infection history, and CMV or EBV mismatch (donor positive/ recipient negative). In the absence of these clinical factors, the alemtuzumab protocol was used.

*Results: There were 355 basiliximab induction cases and 455 alemtuzumab There was no difference between both groups with regards to age, sex, the type of lung transplant, BMI, acute kidney injury required renal replacement therapy, bronchitis obliterans syndrome. Basiliximab group had higher LAS (p=0.04) experienced more acute cellular rejection within one year (p=0.02), bronchial dehiscence (p < 0.001). The overall survival rate of the alemtuzumab group was significantly better than basiliximab group (5 years survival rate: 63.1% vs 53.6%, p=0.003)

*Conclusions: Based on our analysis, patients that received basiliximab induction for lung transplantation experienced more bronchial dehiscence and acute cellular rejection. Alemtuzumab induction showed better survival than basiliximab induction.

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