The most extensively used antifungal preventive medicines in lung transplant recipients have inhaled forms of amphotericin B, but there was minimal data on their safety. Researchers conducted a single-center retrospective cohort study of 603 consecutive patients who received antifungal prophylaxis with inhaled amphotericin B lipid complex (iABLC) from transplantation to hospital discharge between 2012 and 2017. About 600 (99.5%) of the 603 patients received more than or equal to 1 iABLC dose, and 544 (90.2%) completed the prescribed preventive course. 4,128 iABLC doses (median 5, range 1 to 48 per patient) were given, with 24 patients receiving treatment for more than 3 months. Only 1 patient (0.2%) discontinued treatment due to a drug-related adverse event. However, 80 (13.3%) patients died in the first year after transplantation (median time to death: 171 days; IQR: 80 to 272 days), and 3,352 (median, 6 per patient) lung biopsies were conducted; 414 (68.7%) patients had biopsy-proven acute cellular rejection. The sample of lung transplant recipients treated with iABLC during transplant hospitalization had 1-year adverse events that matched national rejection, graft loss, and death rates.