Mushroom poisoning is a rare cause of fulminant liver failure. Liver transplantation plays an important role in the treatment of those with acute liver failure. We reviewed the outcomes of the children with fulminant liver failure secondary to mushroom poisoning treated with liver support modalities and living-related liver transplantation. Four children (3 male, age 2.5-11 years) were referred to our hospital with fulminant liver failure due to mushroom poisoning between 2000-2004. First noticed symptoms were vomiting, nausea, abdominal pain and diarrhea began 8-16 hours after mushroom ingestion. Treatment modalities in the first level health centers were gastric irrigation, oral active charcoal, intravenous hydration, and intravenous penicilline G. One patient was commenced on silimarine. Patients were referred to our hospital following 4-6 days of mushroom ingestion. Two patients had stage IV, one had stage III and one had stage II hepatic encephalopathy. Range of serum AST and ALT levels were 1530-4170 IU/ml and 3600-4520 IU/ml. Protrombin times of the patients were increased to 20-70 seconds. Range of total and direct bilirubin levels were 4.6-9 mg/dl and 1.2-4 mg/dl respectively. Three patients had severe hypoglycemia except the one who survived without liver transplantation. We treated them with charcoal hemoperfusion and/or plasmapheresis. One patient with stage II hepatic encephalopathy survived with supportive therapy. Two patients with stage IV hepatic encephalopathy died after 16 hours and seven days later with multiorgan failure. Liver necropsies demonstrated massive necrosis and hepatosteatosis. The 10-year-old patient with stage III hepatic encephalopathy underwent living-related right lob orthotopic liver transplantation at the same day upon arrival for fulminant liver failure. The explanted liver revealed massive hepatic necrosis compatible with toxic injury. He was discharged 20 days later without any problems. Fulminant liver failure due to mushroom poisoning needs early and aggressive multidisciplinary care. Severity of hepatic encephalopathy, coagulopathy and hypoglycemia predict a poor outcome whereas the degree of bilirubin and aminotransferases elevation may not. Early consideration and referral for liver transplantation is essential in order to facilitate the search for suitable donor liver. Liver transplantation can be life saving for those with unfavourable outcome.