Abstract： Objective:To investigate the clinical characteristics of lung transplantation in the treatment of end-stage idiopathic pulmonary fibrosis complicated with flat chest and to describe the advances in donor-recipient size matching.Methods:A 40-year-old female patient was admitted with "intermittent cough accompanied by chest tightness and shortness of breath for 2 years, aggravated for 1 month". At the age of 38 years, she was diagnosed with idiopathic pulmonary fibrosis. With the progression of the disease, the lung capacity gradually decreased, the thoracic wall gradually flattened, and the diaphragm gradually lifted. The clinical data and literature review were retrospectively analyzed. "Lung transplantation" and "flat chest" were used as search terms to search the Chinese literature databases of CNKI and Wanfang Medical Network, and "lung transplantation" and "flat chest" were used as search terms to search the PubMed database until July 2022.Results:On July 26, 2021, we successfully completed the sequential double lung transplantation for the patient. Extracorporeal membrane oxygenation (ECMO) and mechanical ventilation were successfully weaned off for 18 h, 38 h postoperatively, respectively, and the patient was discharged from hospital two weeks after operation. Her chest wall flattening gradually improved after the transplant. At present, 1 year after lung transplantation, the follow-up condition of the patient was well. Nine relevant English literatures were retrieved, except for one review article. Among them, 43 cases (22 males and 21 females, aged 24 to 58 years) had relatively complete data in 5 literatures. There were 11 cases of living bilateral lobar transplantation, 14 cases of cadaveric double lung transplantation, and 18 cases of cadaveric single lung transplantation. In addition, there were still 3 literatures on the preliminary discussion and analysis of patients with lung transplantation complicated with flat chest, but the patient information was not clear.Conclusions:For patients with end-stage restrictive lung disease complicated with acquired flat chest and receiving lung transplantation, a slightly larger donor lung can be selected appropriately, and perioperative intensive pulmonary rehabilitation exercise training can help to reverse flat chest and improve lung function after transplantation.