Recently inhaled nitric oxide (iNO) has been used as pulmonary vasodilator without any effect on systemic hemodynamics. iNO has been also used in cardiac and thoracic surgery, involving lung transplantation. In this case report a patient, 41 years old female, affected by bronchiectasis, underwent bilateral sequential single lung transplantation and during one lung ventilation and pulmonary artery clamped iNO allowed to avoid cardiopulmonary bypass and to carry out the procedure successfully.