After more than two decades of rapid development in the new era, the volume of lung transplant surgeries in China now ranks among the top internationally, with the perioperative survival rate now approaching internationally advanced levels. However, the long-term survival rate of lung transplantation in China—particularly the 5-year and beyond survival rate—still lags behind that of leading international transplant centers. This article will analyze three major challenges affecting long-term survival in China: balancing infection and immunosuppression, managing chronic lung allograft dysfunction (CLAD), and establishing a lifelong follow-up system. Based on this analysis, specific strategies centered on "meticulous perioperative management" and "lifelong management" are proposed. Enhancing the long-term survival rate of lung transplantation requires not only continuous breakthroughs in surgical techniques but also the establishment of a lifelong management philosophy aimed at long-term survival, guided by high-level evidence, and founded on multidisciplinary collaboration.