Alpha1-antitrypsin deficiency (AATD) is characterized by low level of apha-1 antitrypsin, which predispose lung to unprotected proteolytic activity. We observed in our centre that patients with AATD suffer from severe bronchial anastomotic complication. We wanted to determine whether there is difference in post-transplant airway complications between AATD emphysema and emphysema without AATD (EMPH). We performed a retrospective analysis to compare the post-transplantation course of patients with AATD and EMPH. Data collection includes demographic and functional baseline of recipients, primary outcome as bronchial anastomotic complication and secondary end points as survival data. A total of 163 patients were transplanted from January 2005 to May 2016 in our centre, with follow up until August 2016. Out of these, 34 patients had either diagnosis of AATD (35.3%) or EMPH(64.7%). There was a male preponderance of 75% in AATD. Both groups had predominantly double lung transplant. Population with AATD was younger compare to EMPH (mean age 53.5 ± 7.9 vs 60 ± 4.6, p ‹ 0.01). There was no statistical difference in FEV1 pre and post-transplant between groups. 4 (33%) AATD patients had bronchial anastomotic complication (versus 0 in EMPH, p value = 0.011) with median onset 4 months post-transplant, and odd ratio of 1.5 (95%CI, 1.005-2.238). Survival curve showed no difference between both group (p=0.512) with mean survival AATD 29.6 ± 4.3 months and EMPH 44.2 ± 10.8 months. This observation study extends the available knowledge. The findings indicate that AATD patients may have higher risk for developing bronchial anastomotic complication. More robust data and multicentre analysis would be needed for further confirmation.