Summary Outcomes after transplantation of lungs (LuTX) treated with ex‐vivo lung perfusion (EVLP) are debated. In a single‐center 8 years of retrospective analysis, we compared: donors’ and recipients’ characteristics, gas exchange and lung mechanics at ICU admission, 3, 6, and 12 months, and patients’ survival of LuTX from standard donors compared with EVLP‐treated grafts. A total of 193 LuTX were performed. Thirty‐one LuTX, out of 50 EVLP procedures, were carried out: 7 from nonheart beating and 24 from extended criteria brain‐dead donors. Recipients’ characteristics were similar. At ICU admission, compared with standard donors, EVLP patients had worse PaO2/FiO2 276 (206; 374) vs. 204 (133; 245) mmHg, P < 0.05, more frequent extracorporeal support (18% vs. 32%, P = 0.053) and longer mechanical ventilation duration 28 days of ventilator‐free days: 27 (24; 28) vs. 26 (19; 27), P < 0.05. ICU length of stay 4 (2; 9) vs. 6 (3; 12) days, P = 0.208, 28‐day survival (99% vs. 97%, P = 0.735), and 1‐year respiratory function were similar between groups. Log‐rank analysis (median follow‐up 2.5 years) demonstrated similar patients’ survival (P = 0.439) and time free of chronic lung allograft disease (P = 0.484). The EVLP program increased by 16% the number of LuTX. Compared to standard donors, EVLP patients had worse respiratory function immediately after LuTX but similar early and mid‐term outcomes.