Gastroparesis is a serious complication of lung and heart–lung transplantation that can lead to malnutrition, gastroesophageal reflux, aspiration pneumonia and deteriorating lung function. Some patients with severe gastroparesis have symptoms that are refractory to dietary modifications and gastric promotility agents and require surgery. We describe the successful use of gastric pacing for the management of intractable gastroparesis, malnutrition and recurrent aspiration in a heart–lung allograft recipient. Lung transplant recipients with severe gastroparesis may benefit from gastric pacing.