Liver transplantation was historically associated with massive blood loss. Many factors have contributed to the decline in bleeding and transfusion in the past two decades including refinement of surgical techniques, anesthetics management and the use of point of care guided goal-directed hemostatic therapies. Increasing awareness of the adverse associations of allogenic transfusion has driven the quest for transfusion-free transplantation. Pre-operative management of preoperative anemia and targeted correction of coagulopathy is done to decrease blood transfusion. Liver transplantation is associated with the potential for massive operative blood loss, which has been recognized as one of the main causes of morbidity and mortality after liver transplantation. Therefore, a fine surgical procedure to reduce intraoperative hemorrhage is necessary for favorable outcomes of liver transplantation.

Inclusion Criteria:

• All patients undergoing Living Donor Liver Transplantation accepted according to hospital protocol
• All patients with liver Cirrhosis who have Porto systemic collaterals based on ct angiography

Exclusion Criteria:

• Acute fulminant liver failure

We will included in the study all patients accepted for Living Donor LiverTransplantation (LDLT) according to hospital protocol