Indications of liver transplantation include: Hepatocellular diseases as liver cirrhosis and chronic hepatitis. Inborn errors of metabolism on Wilson’s disease and alpha 1-antitrypsin deficiency. Chemically induced liver damage such as by aspirin, phenytoin and INH. Cholestatic diseases as sclerosing cholangitis and biliary cirrhosis. In addition to vascular diseases and primary tumour of the liver. Pre-operative evaluation of the recipient occur in 2 separate steps and includes careful assessment of whole body systems such as: Respiratory system by chest X-ray,arterial blood gases and pulmonary function tests. Cardiovascular system by ECG and echocardiography. Renal function and electrolyte balance. Metabolic function to exclude hypoglycemia or hypoalbuminemia. Central nervous system to exclude encephalopathy. In addition to proper immunological and nutritional evaluation: Immediate pre-operative preparation includes repetition of labs and reassessment of the patient in addition to proper coordination with the blood bank for possibility of the need for rapid infusion of large amounts of blood and its products. Intra-operatively anesthetic management is divided according to surgical steps into pre-anhepatic, anhepatic and neohepatic stages, each stage needs close monitoring and careful anesthetic management with special care of cardiovascular stability, electrolyte balance and management of coagulopathy. Post-operative care of the liver transplant recipient should be a multidisciplinary effort involving the transplant surgeon, an intinsivist, and experienced hepatologist. Daily rounds by the multidisciplinary team of physicians, nurses and supporting personnel are essential for developing a comprehensive daily and nursing care plan. This is important for avoiding and detecting postoperative complications and managing them early as possible as they can.