<h3>Purpose</h3> The standard immunosuppressive therapy after lung transplantation is a combination of calcineurin inhibitors (CNIs), antimetabolites, and corticosteroids. In the cases where CNIs need to be reduced or discontinued early after transplantation due to renal dysfunction or other side effects, basiliximab is used as an alternative at our hospital. In this study, we investigated the efficacy and safety of basiliximab administered early after transplantation as an alternative of CNIs. <h3>Methods</h3> All lung transplant recipients between April 2002 and April 2021 at our hospital were retrospectively reviewed. Among 272 lung transplant recipients (108 living-donor, 163 deceased-donor, and 1 hybrid), 18 recipients were treated with basiliximab due to the need for CNI reduction or discontinuation. We reviewed indications of basiliximab and the outcome. Acute rejection was diagnosed based on radiologic and clinical parameters without transbronchial biopsy. The incidence of clinically diagnosed acute rejection and that of chronic lung allograft dysfunction (CLAD) were compared between the basiliximab group (n = 18) and the non-basiliximab group (n = 254). <h3>Results</h3> The indications of basiliximab were preoperatively existing poor renal function (n = 11) postoperative acute kidney disease (eGFR < 50, n = 4), and posterior reversible encephalopathy syndrome (PRES, n = 3) due to CNIs. The first dose of basiliximab (20 mg for adults, 10 mg for children) was administered postoperatively (median 0, range 0-7 days) and the second dose was administered 4 days later. No apparent adverse effects were encountered. None of the recipients with poor renal function required dialysis in the perioperative period, and all the recipients with PRES showed complete recovery. The incidence of clinically diagnosed acute rejection before discharge was 44.4% in the basiliximab group and 41.3% in the non-basiliximab group (<i>p</i> = 0.81). Five-year CLAD-free survival was 50% in the basiliximab group and 60.6% in the non-basiliximab group (<i>p</i> = 0.41). <h3>Conclusion</h3> The use of basiliximab as an alternative of CNIs early after lung transplantation was safe and increased neither the risk of acute rejection nor CLAD.