Liver transplantation has become the only curative therapy for children with end stage liver disease.The use of living-related grafts has increased the available number of organs for transplantation.Understanding the pathophysiology of end-stage liver disease has an improvement of the results of liver transplantation.The major parameters considered in selecting patients for liver transplantation include disease category, clinical status and presence of possible contraindications.Multiple anesthetic challenges are seen in pediatric living-related liver transplantation. Intraoperatively, it is essential to stabilize the physiological condition and prevent extreme hemodynamic changes. This is achieved by refinement of intraoperative devices (e.g. rapid infusion pump and venovenous bypass) and coagulation monitoring and experience gained in postoperative care. Also, acid-base and electrolyte imbalance, hypoglycemia and hypothermia are major challenges that face anesthesiologists. Following advances in preservation, patient selection and control of rejection, patient survival rates increased. Improved anesthetic management with application of safe anesthetic drugs as isoflurane is a reason of enhanced outcome.