Liver transplantation (LT) is the replacement of a diseased liver with a healthy liver allograft. It has been recognized as the only definitive treatment of end stage liver disease. It increases both life expectancy and quality of life for patients, and it can be the definitive cure for some acquired and genetic liver diseases. Indications for liver transplantation include acute liver failure, hepatic decompensation due to chronic liver disease, primary hepatic malignancy and a variety of metabolic disorders. In 2012 a total of 6973 livers were transplanted in the European Union (EU), with live liver donations making up 3.7% of these. Globally, the percentage of live liver donations made up 18.2% of a total number of 23986. In 2013,1562 livers were transplanted within the Eurotransplant area, which includes Austria, Belgium, Croatia, Germany, Hungary, Luxembourg, the Netherlands and Slovenia. Liver transplants had the highest quality adjusted life years (QALYs) gained with 11.5, compared to heart and lung transplants, with 6.8 and 5.2 QALYs gained, respectively. The survival rates for deceased donor transplantations are approximately 86 and 72 percent for 1 and 5 years, respectively, and for living donor transplantations the survival rates are 90 and 78 percent. Because there is a lack of donors and a relative high demand for donor livers, and also because invasive testing during patient selection and preoperative screening can pose dangers, it is important to identify the patients who will benefit the most from the procedure. Advanced liver disease affects all other organ system, and it requires a skilled anesthesiologist to manage the complications that can arise before and during surgery. The surgery is divided into three phases, preanhepatic (stage I), anhepatic (stage II) and neo-hepatic (stage III), and the anesthetic management is described according to these stages, with each posing different challenges for the anesthesiologist.